| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
8,410 |
7,836 |
$355K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,181 |
2,476 |
$275K |
| D0120 |
Periodic oral evaluation - established patient |
9,787 |
9,119 |
$198K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,472 |
1,975 |
$181K |
| D2335 |
|
1,106 |
559 |
$156K |
| D0210 |
Intraoral - complete series of radiographic images |
2,807 |
2,492 |
$144K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,614 |
1,162 |
$129K |
| D1351 |
Sealant - per tooth |
5,388 |
1,112 |
$119K |
| D0274 |
Bitewings - four radiographic images |
3,768 |
3,510 |
$109K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,661 |
2,466 |
$87K |
| D1120 |
Prophylaxis - child |
2,891 |
2,674 |
$74K |
| D1206 |
Topical application of fluoride varnish |
2,923 |
2,694 |
$57K |
| D0330 |
Panoramic radiographic image |
1,121 |
1,045 |
$51K |
| D0140 |
Limited oral evaluation - problem focused |
1,553 |
1,438 |
$48K |
| D2394 |
|
443 |
322 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,064 |
1,886 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
2,801 |
2,562 |
$26K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
965 |
845 |
$25K |
| D2332 |
|
197 |
127 |
$21K |
| D2330 |
|
225 |
142 |
$17K |
| D0272 |
Bitewings - two radiographic images |
880 |
803 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
769 |
352 |
$5K |
| D2331 |
|
17 |
12 |
$1K |
| D1999 |
|
341 |
288 |
$220.72 |