| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,147 |
2,096 |
$73K |
| D1110 |
Prophylaxis - adult |
1,173 |
1,142 |
$60K |
| D0210 |
Intraoral - complete series of radiographic images |
1,237 |
1,201 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,120 |
3,048 |
$38K |
| D1120 |
Prophylaxis - child |
1,823 |
1,790 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
1,130 |
1,110 |
$31K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
611 |
241 |
$28K |
| D9430 |
|
874 |
827 |
$16K |
| D0274 |
Bitewings - four radiographic images |
792 |
782 |
$9K |
| D1999 |
|
151 |
151 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,634 |
1,551 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,142 |
1,092 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
142 |
77 |
$8K |
| D1351 |
Sealant - per tooth |
314 |
79 |
$6K |
| D9999 |
Unspecified adjunctive procedure, by report |
120 |
120 |
$5K |
| D0350 |
|
1,220 |
337 |
$4K |
| D1206 |
Topical application of fluoride varnish |
122 |
122 |
$2K |
| D2331 |
|
23 |
13 |
$1K |
| D0170 |
|
25 |
25 |
$975.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
15 |
15 |
$885.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
12 |
$764.40 |
| D9995 |
|
50 |
23 |
$302.40 |
| D9993 |
|
745 |
694 |
$65.00 |
| D1310 |
|
740 |
694 |
$46.00 |
| D0270 |
|
27 |
27 |
$20.00 |
| D0601 |
|
145 |
137 |
$15.00 |
| D9986 |
|
99 |
86 |
$0.00 |
| D0603 |
|
292 |
273 |
$0.00 |