| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,720 |
6,715 |
$220K |
| D0274 |
Bitewings - four radiographic images |
7,246 |
7,242 |
$133K |
| D9990 |
|
5,854 |
5,362 |
$119K |
| D0120 |
Periodic oral evaluation - established patient |
5,575 |
5,571 |
$102K |
| D0220 |
Intraoral - periapical first radiographic image |
7,278 |
7,268 |
$62K |
| D1354 |
|
2,857 |
937 |
$61K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,281 |
7,270 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,743 |
2,743 |
$53K |
| D1120 |
Prophylaxis - child |
1,275 |
1,274 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,984 |
2,983 |
$32K |
| D1351 |
Sealant - per tooth |
474 |
155 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
264 |
118 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
1,482 |
1,475 |
$19K |
| D9430 |
|
346 |
282 |
$3K |
| D9995 |
|
104 |
102 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
53 |
27 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
15 |
14 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
81 |
80 |
$571.06 |
| D0330 |
Panoramic radiographic image |
27 |
27 |
$556.28 |
| D1999 |
|
42 |
35 |
$0.00 |
| D1310 |
|
12 |
12 |
$0.00 |