| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9920 |
|
2,932 |
2,843 |
$404K |
| D0120 |
Periodic oral evaluation - established patient |
2,953 |
2,937 |
$191K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,904 |
2,896 |
$184K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,134 |
3,074 |
$64K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
936 |
522 |
$61K |
| D0210 |
Intraoral - complete series of radiographic images |
1,259 |
1,251 |
$58K |
| D1110 |
Prophylaxis - adult |
654 |
645 |
$56K |
| D4341 |
|
602 |
253 |
$41K |
| D4910 |
|
548 |
548 |
$41K |
| D0274 |
Bitewings - four radiographic images |
1,948 |
1,932 |
$40K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
616 |
326 |
$32K |
| D9410 |
|
1,155 |
1,130 |
$29K |
| D1206 |
Topical application of fluoride varnish |
1,615 |
1,609 |
$25K |
| D9993 |
|
352 |
352 |
$22K |
| D1120 |
Prophylaxis - child |
567 |
567 |
$19K |
| D9430 |
|
529 |
507 |
$16K |
| D1310 |
|
352 |
352 |
$16K |
| D0145 |
Oral evaluation for a patient under three years of age |
170 |
170 |
$10K |
| D0350 |
|
1,062 |
500 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
469 |
462 |
$5K |
| D0602 |
|
236 |
236 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
38 |
12 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
56 |
33 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
41 |
26 |
$3K |
| D0603 |
|
78 |
78 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$159.25 |
| D9996 |
|
691 |
681 |
$0.00 |