| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,928 |
7,769 |
$264K |
| D1120 |
Prophylaxis - child |
7,551 |
7,386 |
$221K |
| D1206 |
Topical application of fluoride varnish |
7,586 |
7,423 |
$187K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
364 |
277 |
$161K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,495 |
2,450 |
$95K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,514 |
1,155 |
$85K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,939 |
8,259 |
$81K |
| D0274 |
Bitewings - four radiographic images |
6,432 |
6,289 |
$80K |
| D9999 |
Unspecified adjunctive procedure, by report |
909 |
850 |
$78K |
| D0220 |
Intraoral - periapical first radiographic image |
9,813 |
9,544 |
$77K |
| D1110 |
Prophylaxis - adult |
1,062 |
1,040 |
$66K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
511 |
451 |
$25K |
| D0210 |
Intraoral - complete series of radiographic images |
980 |
969 |
$24K |
| D1351 |
Sealant - per tooth |
940 |
224 |
$24K |
| D9430 |
|
640 |
636 |
$17K |
| D1310 |
|
1,029 |
1,019 |
$16K |
| D0330 |
Panoramic radiographic image |
709 |
709 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
250 |
180 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
619 |
610 |
$8K |
| D9110 |
|
332 |
307 |
$8K |
| D0999 |
Unspecified diagnostic procedure, by report |
97 |
97 |
$6K |
| D0272 |
Bitewings - two radiographic images |
1,010 |
985 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
579 |
574 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
47 |
33 |
$5K |
| D1999 |
|
111 |
110 |
$5K |
| D0603 |
|
957 |
929 |
$3K |
| D0270 |
|
977 |
948 |
$3K |
| D1320 |
|
274 |
274 |
$2K |
| D0350 |
|
113 |
110 |
$1K |
| D0602 |
|
304 |
304 |
$1K |
| D2394 |
|
14 |
12 |
$805.00 |
| D0601 |
|
118 |
114 |
$449.00 |
| D1330 |
|
30 |
30 |
$0.00 |