| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,489 |
4,400 |
$246K |
| D0120 |
Periodic oral evaluation - established patient |
5,916 |
5,799 |
$190K |
| D1206 |
Topical application of fluoride varnish |
5,151 |
5,037 |
$136K |
| D0274 |
Bitewings - four radiographic images |
2,820 |
2,754 |
$111K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,642 |
891 |
$93K |
| D1120 |
Prophylaxis - child |
2,488 |
2,440 |
$87K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,003 |
586 |
$58K |
| D0220 |
Intraoral - periapical first radiographic image |
2,579 |
2,508 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,385 |
1,712 |
$40K |
| D0330 |
Panoramic radiographic image |
507 |
494 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
851 |
817 |
$25K |
| D0272 |
Bitewings - two radiographic images |
798 |
777 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
442 |
422 |
$13K |
| D2331 |
|
59 |
40 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
57 |
40 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
13 |
12 |
$1K |
| D9985 |
|
419 |
320 |
$0.00 |
| D2330 |
|
68 |
40 |
$0.00 |
| D0602 |
|
31 |
26 |
$0.00 |