| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,032 |
9,021 |
$554K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,233 |
6,631 |
$544K |
| D1110 |
Prophylaxis - adult |
6,181 |
6,172 |
$525K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
9,227 |
6,135 |
$493K |
| D0120 |
Periodic oral evaluation - established patient |
6,617 |
6,608 |
$357K |
| D0210 |
Intraoral - complete series of radiographic images |
6,508 |
6,506 |
$310K |
| D9430 |
|
5,971 |
5,877 |
$187K |
| D0330 |
Panoramic radiographic image |
6,322 |
6,319 |
$185K |
| D2330 |
|
2,318 |
1,453 |
$174K |
| D0274 |
Bitewings - four radiographic images |
7,749 |
7,738 |
$163K |
| D0220 |
Intraoral - periapical first radiographic image |
9,130 |
8,901 |
$108K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22,620 |
12,618 |
$89K |
| D3221 |
|
1,031 |
1,021 |
$65K |
| D2740 |
Crown - porcelain/ceramic |
101 |
80 |
$51K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
633 |
558 |
$50K |
| D0270 |
|
6,639 |
6,541 |
$33K |
| D9999 |
Unspecified adjunctive procedure, by report |
1,321 |
1,248 |
$33K |
| D9110 |
|
396 |
394 |
$25K |
| D2331 |
|
259 |
198 |
$20K |
| D1120 |
Prophylaxis - child |
448 |
447 |
$16K |
| D4910 |
|
69 |
69 |
$5K |
| D2940 |
|
51 |
51 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
19 |
13 |
$1K |
| D4342 |
|
27 |
13 |
$1K |
| D0272 |
Bitewings - two radiographic images |
60 |
60 |
$621.50 |
| D1208 |
Topical application of fluoride, excluding varnish |
49 |
49 |
$396.00 |
| D9995 |
|
14 |
14 |
$41.52 |