| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,937 |
1,907 |
$103K |
| D1110 |
Prophylaxis - adult |
1,203 |
1,191 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
1,891 |
1,859 |
$70K |
| D9430 |
|
2,166 |
1,981 |
$57K |
| D0210 |
Intraoral - complete series of radiographic images |
1,481 |
1,463 |
$49K |
| D1120 |
Prophylaxis - child |
1,222 |
1,213 |
$46K |
| D1206 |
Topical application of fluoride varnish |
2,170 |
2,134 |
$33K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
445 |
287 |
$24K |
| D0274 |
Bitewings - four radiographic images |
2,035 |
2,015 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,511 |
2,867 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
341 |
205 |
$16K |
| D2740 |
Crown - porcelain/ceramic |
34 |
27 |
$15K |
| D0330 |
Panoramic radiographic image |
401 |
392 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
2,300 |
2,182 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
493 |
492 |
$9K |
| D9999 |
Unspecified adjunctive procedure, by report |
53 |
53 |
$6K |
| D9310 |
|
80 |
79 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
16 |
12 |
$1K |
| D0270 |
|
43 |
41 |
$149.00 |
| D1999 |
|
76 |
69 |
$20.00 |
| D1330 |
|
42 |
37 |
$0.00 |