| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,993 |
3,956 |
$160K |
| D0120 |
Periodic oral evaluation - established patient |
2,355 |
2,337 |
$144K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
770 |
374 |
$31K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
682 |
399 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
366 |
366 |
$22K |
| D0330 |
Panoramic radiographic image |
2,937 |
2,898 |
$21K |
| D1330 |
|
4,043 |
3,974 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,613 |
5,128 |
$13K |
| D1110 |
Prophylaxis - adult |
1,498 |
1,484 |
$13K |
| D9310 |
|
342 |
339 |
$12K |
| D0272 |
Bitewings - two radiographic images |
5,532 |
5,479 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
698 |
681 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,791 |
2,751 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
6,083 |
5,989 |
$8K |
| D1351 |
Sealant - per tooth |
1,791 |
484 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
249 |
160 |
$7K |
| D2332 |
|
155 |
72 |
$6K |
| D4355 |
|
180 |
179 |
$5K |
| D1120 |
Prophylaxis - child |
1,197 |
1,187 |
$3K |
| D1206 |
Topical application of fluoride varnish |
580 |
567 |
$3K |
| D8670 |
Periodic orthodontic treatment visit |
28 |
12 |
$1K |
| D9999 |
Unspecified adjunctive procedure, by report |
18 |
18 |
$450.00 |
| D0601 |
|
146 |
143 |
$345.00 |
| D0274 |
Bitewings - four radiographic images |
27 |
27 |
$243.85 |
| D0340 |
|
25 |
25 |
$92.56 |