| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,450 |
5,278 |
$230K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,384 |
7,158 |
$153K |
| D0120 |
Periodic oral evaluation - established patient |
6,082 |
5,908 |
$145K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,966 |
948 |
$141K |
| D2740 |
Crown - porcelain/ceramic |
211 |
141 |
$103K |
| D0330 |
Panoramic radiographic image |
2,210 |
2,151 |
$93K |
| D1120 |
Prophylaxis - child |
2,726 |
2,654 |
$91K |
| D2950 |
|
543 |
347 |
$66K |
| D0274 |
Bitewings - four radiographic images |
2,474 |
2,391 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,720 |
1,669 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
3,636 |
3,405 |
$40K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,787 |
1,769 |
$38K |
| D0272 |
Bitewings - two radiographic images |
2,413 |
2,348 |
$36K |
| D1351 |
Sealant - per tooth |
782 |
255 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
824 |
799 |
$18K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
29 |
26 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
105 |
66 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
135 |
77 |
$9K |
| D1999 |
|
180 |
170 |
$0.00 |
| D9986 |
|
80 |
76 |
$0.00 |
| D1330 |
|
699 |
692 |
$0.00 |