| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,324 |
1,324 |
$86K |
| D1120 |
Prophylaxis - child |
1,336 |
1,332 |
$70K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
436 |
220 |
$29K |
| D1110 |
Prophylaxis - adult |
244 |
244 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,274 |
1,274 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,326 |
1,281 |
$14K |
| D9430 |
|
401 |
399 |
$13K |
| D0274 |
Bitewings - four radiographic images |
586 |
584 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
151 |
98 |
$12K |
| D1310 |
|
258 |
258 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
155 |
113 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
143 |
86 |
$8K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
15 |
13 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
87 |
44 |
$6K |
| D0350 |
|
585 |
282 |
$6K |
| D0272 |
Bitewings - two radiographic images |
376 |
376 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
104 |
92 |
$4K |
| D0603 |
|
127 |
127 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
37 |
37 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
136 |
136 |
$2K |
| D0601 |
|
100 |
100 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
29 |
29 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$708.00 |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$555.00 |
| D9993 |
|
258 |
258 |
$0.00 |