| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
10,204 |
10,150 |
$616K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,455 |
6,411 |
$527K |
| D5110 |
|
221 |
220 |
$197K |
| D0330 |
Panoramic radiographic image |
6,385 |
6,353 |
$107K |
| D1110 |
Prophylaxis - adult |
12,158 |
12,093 |
$93K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,150 |
959 |
$67K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,402 |
1,103 |
$57K |
| D4355 |
|
1,160 |
1,151 |
$41K |
| D1206 |
Topical application of fluoride varnish |
11,912 |
11,854 |
$40K |
| D9999 |
Unspecified adjunctive procedure, by report |
517 |
501 |
$34K |
| D0140 |
Limited oral evaluation - problem focused |
1,191 |
1,181 |
$21K |
| D0272 |
Bitewings - two radiographic images |
7,547 |
7,496 |
$18K |
| D5213 |
|
26 |
26 |
$17K |
| D2950 |
|
142 |
104 |
$12K |
| D2740 |
Crown - porcelain/ceramic |
32 |
26 |
$12K |
| D5214 |
|
33 |
33 |
$11K |
| D1120 |
Prophylaxis - child |
2,297 |
2,280 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
2,558 |
2,445 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
90 |
68 |
$8K |
| D1330 |
|
15,140 |
15,056 |
$7K |
| D0274 |
Bitewings - four radiographic images |
1,099 |
1,092 |
$6K |
| D2332 |
|
61 |
46 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
42 |
40 |
$3K |
| D2331 |
|
35 |
28 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
36 |
12 |
$2K |
| D0601 |
|
1,286 |
1,286 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,978 |
2,963 |
$1K |
| D2140 |
|
20 |
16 |
$744.93 |
| D9995 |
|
24 |
18 |
$635.00 |
| D2330 |
|
31 |
24 |
$608.12 |
| D5120 |
|
36 |
36 |
$550.00 |
| D1999 |
|
73 |
73 |
$540.00 |
| D0999 |
Unspecified diagnostic procedure, by report |
26 |
26 |
$520.00 |
| D1351 |
Sealant - per tooth |
29 |
15 |
$342.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
369 |
347 |
$281.05 |
| D0602 |
|
233 |
233 |
$257.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
14 |
12 |
$166.13 |
| D9986 |
|
327 |
269 |
$0.00 |