| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,440 |
3,428 |
$220K |
| D0210 |
Intraoral - complete series of radiographic images |
1,743 |
1,731 |
$79K |
| D1110 |
Prophylaxis - adult |
686 |
686 |
$58K |
| D0120 |
Periodic oral evaluation - established patient |
893 |
889 |
$57K |
| D1310 |
|
1,580 |
1,580 |
$56K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
851 |
398 |
$56K |
| D9993 |
|
927 |
927 |
$49K |
| D1120 |
Prophylaxis - child |
1,661 |
1,660 |
$47K |
| D1206 |
Topical application of fluoride varnish |
2,866 |
2,863 |
$41K |
| D9430 |
|
1,217 |
1,069 |
$39K |
| D0330 |
Panoramic radiographic image |
1,259 |
1,256 |
$36K |
| D4910 |
|
443 |
440 |
$34K |
| D0350 |
|
2,783 |
837 |
$26K |
| D9221 |
|
183 |
110 |
$24K |
| D0340 |
|
487 |
486 |
$24K |
| D9220 |
|
97 |
97 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
432 |
194 |
$21K |
| D0274 |
Bitewings - four radiographic images |
747 |
741 |
$15K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
119 |
26 |
$14K |
| D0601 |
|
1,025 |
1,025 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,246 |
956 |
$9K |
| D4341 |
|
170 |
53 |
$9K |
| D9610 |
|
118 |
111 |
$8K |
| D7240 |
Removal of impacted tooth - completely bony |
33 |
16 |
$8K |
| D2740 |
Crown - porcelain/ceramic |
13 |
12 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
62 |
39 |
$5K |
| D0603 |
|
386 |
386 |
$4K |
| D7230 |
|
19 |
13 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
112 |
112 |
$2K |
| D2330 |
|
31 |
12 |
$2K |
| D0602 |
|
131 |
131 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
22 |
22 |
$1K |
| D0999 |
Unspecified diagnostic procedure, by report |
56 |
48 |
$0.00 |