| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,573 |
5,375 |
$250K |
| D0120 |
Periodic oral evaluation - established patient |
9,253 |
9,098 |
$225K |
| D1120 |
Prophylaxis - child |
5,353 |
5,244 |
$178K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,400 |
983 |
$165K |
| D4346 |
|
2,243 |
2,174 |
$162K |
| D1206 |
Topical application of fluoride varnish |
8,516 |
8,311 |
$150K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,796 |
1,168 |
$148K |
| D1351 |
Sealant - per tooth |
5,800 |
1,083 |
$146K |
| D0274 |
Bitewings - four radiographic images |
3,702 |
3,609 |
$106K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,071 |
3,994 |
$71K |
| D0330 |
Panoramic radiographic image |
923 |
886 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,268 |
1,204 |
$48K |
| D0140 |
Limited oral evaluation - problem focused |
807 |
779 |
$31K |
| D4910 |
|
462 |
452 |
$31K |
| D0272 |
Bitewings - two radiographic images |
554 |
540 |
$13K |
| D1354 |
|
645 |
239 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
125 |
118 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
405 |
400 |
$7K |
| D2940 |
|
100 |
69 |
$6K |
| T1013 |
Sign language or oral interpretive services, per 15 minutes |
67 |
54 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
14 |
$3K |
| D0180 |
|
12 |
12 |
$0.00 |
| D9986 |
|
1,568 |
1,513 |
$0.00 |