| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,419 |
3,371 |
$243K |
| D0120 |
Periodic oral evaluation - established patient |
5,022 |
4,951 |
$141K |
| D0330 |
Panoramic radiographic image |
1,912 |
1,882 |
$140K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,524 |
1,280 |
$106K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
619 |
414 |
$68K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,670 |
1,649 |
$48K |
| D1351 |
Sealant - per tooth |
8,605 |
2,052 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,807 |
6,727 |
$24K |
| D0274 |
Bitewings - four radiographic images |
3,394 |
3,347 |
$23K |
| D1120 |
Prophylaxis - child |
3,397 |
3,357 |
$23K |
| D0272 |
Bitewings - two radiographic images |
2,571 |
2,535 |
$13K |
| D1330 |
|
6,878 |
6,792 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
240 |
166 |
$7K |
| D9999 |
Unspecified adjunctive procedure, by report |
202 |
202 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
26 |
26 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
198 |
188 |
$2K |
| D0240 |
|
650 |
500 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
559 |
536 |
$1K |
| D3120 |
|
132 |
97 |
$343.98 |
| D0230 |
Intraoral - periapical each additional radiographic image |
72 |
59 |
$258.00 |
| D0601 |
|
247 |
237 |
$82.00 |
| D0603 |
|
251 |
244 |
$53.00 |
| D0602 |
|
156 |
151 |
$27.00 |