| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,482 |
1,396 |
$81K |
| D2740 |
Crown - porcelain/ceramic |
154 |
118 |
$72K |
| D0350 |
|
8,264 |
2,229 |
$64K |
| D1110 |
Prophylaxis - adult |
587 |
587 |
$53K |
| D0210 |
Intraoral - complete series of radiographic images |
1,174 |
1,138 |
$52K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
458 |
302 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,744 |
1,063 |
$18K |
| D1206 |
Topical application of fluoride varnish |
975 |
971 |
$16K |
| D9430 |
|
624 |
486 |
$14K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
253 |
196 |
$13K |
| D1320 |
|
820 |
815 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
209 |
124 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
147 |
147 |
$11K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
50 |
13 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
493 |
437 |
$5K |
| D0274 |
Bitewings - four radiographic images |
200 |
198 |
$4K |
| D1999 |
|
823 |
746 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
80 |
27 |
$4K |
| D4342 |
|
64 |
27 |
$3K |
| D9995 |
|
102 |
68 |
$2K |
| D1120 |
Prophylaxis - child |
25 |
25 |
$1K |
| D9310 |
|
41 |
35 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$1K |
| D9420 |
|
17 |
16 |
$840.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
21 |
15 |
$720.00 |
| D1310 |
|
14 |
14 |
$644.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
354 |
195 |
$573.12 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$360.00 |
| D0999 |
Unspecified diagnostic procedure, by report |
344 |
192 |
$184.00 |
| D0603 |
|
12 |
12 |
$180.00 |
| D0270 |
|
26 |
26 |
$130.00 |
| D0140 |
Limited oral evaluation - problem focused |
45 |
33 |
$80.00 |
| D4921 |
|
23 |
12 |
$0.00 |
| D0431 |
|
27 |
27 |
$0.00 |