| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
8,453 |
7,845 |
$151K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,457 |
614 |
$119K |
| D1120 |
Prophylaxis - child |
6,425 |
6,003 |
$103K |
| D1206 |
Topical application of fluoride varnish |
7,464 |
7,049 |
$86K |
| D9430 |
|
5,209 |
4,844 |
$75K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,366 |
2,190 |
$64K |
| D1110 |
Prophylaxis - adult |
1,444 |
1,406 |
$60K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,534 |
1,185 |
$52K |
| D0220 |
Intraoral - periapical first radiographic image |
9,741 |
8,789 |
$43K |
| D9999 |
Unspecified adjunctive procedure, by report |
347 |
336 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,126 |
718 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,593 |
9,317 |
$31K |
| D1351 |
Sealant - per tooth |
2,541 |
887 |
$27K |
| D0274 |
Bitewings - four radiographic images |
3,480 |
3,314 |
$24K |
| D0272 |
Bitewings - two radiographic images |
3,814 |
3,556 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
908 |
866 |
$15K |
| D4341 |
|
242 |
106 |
$12K |
| D1310 |
|
804 |
703 |
$6K |
| D0330 |
Panoramic radiographic image |
236 |
236 |
$5K |
| D0270 |
|
2,168 |
2,012 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
56 |
51 |
$3K |
| D0999 |
Unspecified diagnostic procedure, by report |
32 |
32 |
$2K |
| D0601 |
|
429 |
382 |
$1K |
| D9993 |
|
639 |
563 |
$913.00 |
| D2330 |
|
19 |
12 |
$789.76 |
| D4910 |
|
12 |
12 |
$649.00 |
| D0140 |
Limited oral evaluation - problem focused |
211 |
143 |
$280.00 |
| D0602 |
|
191 |
164 |
$168.00 |
| D1999 |
|
407 |
359 |
$70.00 |
| D1330 |
|
7,907 |
7,342 |
$0.00 |
| D0603 |
|
13 |
13 |
$0.00 |
| D9995 |
|
38 |
17 |
$0.00 |
| D9991 |
|
94 |
78 |
$0.00 |