| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
3,694 |
2,838 |
$166K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,968 |
2,991 |
$136K |
| D1110 |
Prophylaxis - adult |
4,000 |
2,952 |
$129K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,706 |
886 |
$122K |
| D0120 |
Periodic oral evaluation - established patient |
2,642 |
2,011 |
$49K |
| D0999 |
Unspecified diagnostic procedure, by report |
1,252 |
270 |
$36K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
614 |
445 |
$21K |
| D0272 |
Bitewings - two radiographic images |
1,653 |
1,443 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
2,154 |
1,838 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
155 |
96 |
$12K |
| D5110 |
|
50 |
32 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
151 |
93 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,219 |
1,344 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
345 |
345 |
$7K |
| D5212 |
|
16 |
12 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
34 |
24 |
$2K |
| D0274 |
Bitewings - four radiographic images |
404 |
122 |
$2K |
| D2331 |
|
15 |
12 |
$1K |
| D1120 |
Prophylaxis - child |
39 |
39 |
$1K |
| D1999 |
|
248 |
198 |
$0.00 |