| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
2,752 |
2,709 |
$404K |
| D1110 |
Prophylaxis - adult |
3,859 |
3,809 |
$282K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,512 |
2,319 |
$276K |
| D1120 |
Prophylaxis - child |
3,740 |
3,665 |
$207K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
487 |
389 |
$65K |
| D9999 |
Unspecified adjunctive procedure, by report |
862 |
842 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,324 |
2,288 |
$41K |
| D2740 |
Crown - porcelain/ceramic |
75 |
49 |
$39K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,045 |
773 |
$38K |
| D1351 |
Sealant - per tooth |
6,153 |
1,765 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
1,357 |
1,322 |
$33K |
| D1206 |
Topical application of fluoride varnish |
7,630 |
7,506 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
5,182 |
5,100 |
$29K |
| D0274 |
Bitewings - four radiographic images |
4,120 |
4,060 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
94 |
59 |
$6K |
| D1330 |
|
7,644 |
7,516 |
$5K |
| D0272 |
Bitewings - two radiographic images |
1,547 |
1,522 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
826 |
813 |
$2K |
| D1999 |
|
29 |
29 |
$2K |
| D2950 |
|
83 |
53 |
$2K |
| D0601 |
|
2,890 |
2,868 |
$1K |
| D0999 |
Unspecified diagnostic procedure, by report |
47 |
47 |
$940.00 |
| D0603 |
|
1,286 |
1,282 |
$279.00 |
| D9440 |
|
52 |
52 |
$229.75 |
| D0145 |
Oral evaluation for a patient under three years of age |
40 |
38 |
$220.00 |
| D0602 |
|
56 |
56 |
$27.00 |
| D9986 |
|
12 |
12 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
34 |
33 |
$0.00 |