| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,888 |
3,823 |
$128K |
| D0210 |
Intraoral - complete series of radiographic images |
2,322 |
2,278 |
$63K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,263 |
1,333 |
$62K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
863 |
459 |
$56K |
| D0120 |
Periodic oral evaluation - established patient |
2,808 |
2,725 |
$56K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,698 |
909 |
$47K |
| D1120 |
Prophylaxis - child |
2,831 |
2,808 |
$38K |
| D1110 |
Prophylaxis - adult |
1,675 |
1,620 |
$34K |
| D9430 |
|
1,787 |
1,640 |
$26K |
| D4341 |
|
580 |
188 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
3,968 |
3,464 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,372 |
3,124 |
$10K |
| D0274 |
Bitewings - four radiographic images |
2,015 |
1,963 |
$9K |
| D1351 |
Sealant - per tooth |
241 |
53 |
$9K |
| D2740 |
Crown - porcelain/ceramic |
13 |
12 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
389 |
389 |
$6K |
| D1206 |
Topical application of fluoride varnish |
1,859 |
1,836 |
$5K |
| D9999 |
Unspecified adjunctive procedure, by report |
27 |
27 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
162 |
129 |
$2K |
| D4910 |
|
25 |
25 |
$2K |
| D2332 |
|
26 |
12 |
$910.00 |
| D2330 |
|
32 |
12 |
$693.00 |
| D0330 |
Panoramic radiographic image |
747 |
705 |
$631.06 |
| D0272 |
Bitewings - two radiographic images |
90 |
90 |
$575.00 |
| D9110 |
|
1,617 |
1,274 |
$20.00 |
| D1330 |
|
1,709 |
1,541 |
$0.00 |
| D0601 |
|
59 |
59 |
$0.00 |
| D1354 |
|
1,047 |
1,030 |
$0.00 |