| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,986 |
1,972 |
$98K |
| D0120 |
Periodic oral evaluation - established patient |
2,117 |
2,065 |
$85K |
| D1120 |
Prophylaxis - child |
2,705 |
2,666 |
$83K |
| D1110 |
Prophylaxis - adult |
1,125 |
1,109 |
$74K |
| D1206 |
Topical application of fluoride varnish |
3,740 |
3,682 |
$50K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
475 |
195 |
$47K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,035 |
779 |
$46K |
| D9430 |
|
1,902 |
1,829 |
$44K |
| D0210 |
Intraoral - complete series of radiographic images |
1,179 |
1,168 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,356 |
3,533 |
$21K |
| D4910 |
|
347 |
346 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
502 |
367 |
$18K |
| D1351 |
Sealant - per tooth |
524 |
186 |
$13K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
44 |
41 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
2,568 |
2,093 |
$10K |
| D0274 |
Bitewings - four radiographic images |
829 |
801 |
$9K |
| D0272 |
Bitewings - two radiographic images |
1,075 |
1,058 |
$9K |
| D9999 |
Unspecified adjunctive procedure, by report |
66 |
58 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
131 |
103 |
$7K |
| D4341 |
|
164 |
60 |
$6K |
| D1310 |
|
181 |
180 |
$5K |
| D0330 |
Panoramic radiographic image |
198 |
198 |
$4K |
| D4342 |
|
38 |
12 |
$1K |
| D9993 |
|
140 |
140 |
$910.00 |
| D0270 |
|
240 |
229 |
$869.08 |
| D0601 |
|
56 |
50 |
$506.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
14 |
14 |
$331.00 |
| D1999 |
|
179 |
160 |
$120.00 |
| D1330 |
|
3,846 |
3,691 |
$0.00 |