| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,022 |
2,992 |
$128K |
| D0120 |
Periodic oral evaluation - established patient |
1,817 |
1,801 |
$86K |
| D1351 |
Sealant - per tooth |
1,703 |
364 |
$37K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
568 |
299 |
$34K |
| D1330 |
|
2,976 |
2,948 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
215 |
124 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
140 |
139 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,810 |
2,784 |
$8K |
| D4346 |
|
142 |
141 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
178 |
113 |
$7K |
| D0330 |
Panoramic radiographic image |
1,643 |
1,624 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
183 |
175 |
$6K |
| D1110 |
Prophylaxis - adult |
1,676 |
1,662 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
329 |
318 |
$5K |
| D0272 |
Bitewings - two radiographic images |
2,886 |
2,856 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
106 |
42 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
4,550 |
4,485 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,298 |
4,169 |
$2K |
| D2335 |
|
41 |
14 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
54 |
41 |
$2K |
| D1120 |
Prophylaxis - child |
723 |
717 |
$2K |
| D0274 |
Bitewings - four radiographic images |
841 |
833 |
$1K |
| D2394 |
|
26 |
15 |
$956.87 |
| D9999 |
Unspecified adjunctive procedure, by report |
17 |
17 |
$820.00 |
| D0601 |
|
87 |
87 |
$408.76 |
| D0999 |
Unspecified diagnostic procedure, by report |
14 |
14 |
$280.00 |
| D0340 |
|
26 |
26 |
$235.87 |
| D4355 |
|
23 |
18 |
$226.78 |
| D1206 |
Topical application of fluoride varnish |
36 |
35 |
$195.23 |
| D0602 |
|
12 |
12 |
$0.00 |