| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,580 |
3,478 |
$113K |
| D0120 |
Periodic oral evaluation - established patient |
4,810 |
4,644 |
$108K |
| D1120 |
Prophylaxis - child |
4,871 |
4,684 |
$100K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,203 |
1,742 |
$79K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,176 |
1,546 |
$70K |
| D1206 |
Topical application of fluoride varnish |
4,461 |
4,294 |
$67K |
| D4341 |
|
1,661 |
517 |
$60K |
| D1110 |
Prophylaxis - adult |
804 |
797 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
8,641 |
7,652 |
$35K |
| D0210 |
Intraoral - complete series of radiographic images |
2,132 |
2,098 |
$34K |
| D9999 |
Unspecified adjunctive procedure, by report |
251 |
241 |
$24K |
| D0274 |
Bitewings - four radiographic images |
3,581 |
3,517 |
$24K |
| D1310 |
|
1,449 |
1,283 |
$22K |
| D9430 |
|
2,387 |
2,097 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,477 |
6,475 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
210 |
194 |
$11K |
| D1999 |
|
9,013 |
7,568 |
$4K |
| D9110 |
|
1,625 |
1,512 |
$3K |
| D0602 |
|
358 |
355 |
$3K |
| D0999 |
Unspecified diagnostic procedure, by report |
40 |
40 |
$2K |
| D0603 |
|
286 |
267 |
$2K |
| D0350 |
|
354 |
142 |
$2K |
| D1351 |
Sealant - per tooth |
426 |
119 |
$1K |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$50.00 |
| D0140 |
Limited oral evaluation - problem focused |
53 |
39 |
$35.00 |
| D1330 |
|
4,030 |
3,813 |
$5.00 |
| D0601 |
|
42 |
26 |
$0.00 |
| D9993 |
|
1,171 |
990 |
$0.00 |
| D9910 |
|
268 |
156 |
$0.00 |
| D0270 |
|
15 |
14 |
$0.00 |