| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,778 |
1,686 |
$138K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,006 |
988 |
$121K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,086 |
1,972 |
$116K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,143 |
645 |
$81K |
| D0210 |
Intraoral - complete series of radiographic images |
1,544 |
1,456 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
1,162 |
1,136 |
$54K |
| D1206 |
Topical application of fluoride varnish |
1,779 |
1,726 |
$45K |
| D1120 |
Prophylaxis - child |
1,195 |
1,149 |
$45K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,171 |
1,461 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
510 |
313 |
$25K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
245 |
135 |
$25K |
| D0274 |
Bitewings - four radiographic images |
1,138 |
1,101 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,955 |
1,848 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,153 |
1,073 |
$15K |
| D9430 |
|
484 |
440 |
$14K |
| D2740 |
Crown - porcelain/ceramic |
24 |
14 |
$11K |
| D1999 |
|
1,257 |
1,038 |
$6K |
| D1310 |
|
416 |
415 |
$6K |
| D1351 |
Sealant - per tooth |
109 |
28 |
$4K |
| D0999 |
Unspecified diagnostic procedure, by report |
27 |
27 |
$2K |
| D0601 |
|
236 |
236 |
$1K |
| D0330 |
Panoramic radiographic image |
31 |
31 |
$930.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
148 |
119 |
$520.00 |
| D9993 |
|
421 |
420 |
$260.00 |
| D0603 |
|
42 |
42 |
$195.00 |
| D9986 |
|
22 |
21 |
$0.00 |