| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,181 |
2,172 |
$104K |
| D0140 |
Limited oral evaluation - problem focused |
1,487 |
1,356 |
$69K |
| D0120 |
Periodic oral evaluation - established patient |
2,265 |
2,252 |
$55K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
734 |
433 |
$41K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
572 |
354 |
$37K |
| D0274 |
Bitewings - four radiographic images |
2,135 |
2,128 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
3,948 |
3,621 |
$25K |
| D1120 |
Prophylaxis - child |
626 |
626 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
452 |
249 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
864 |
863 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,318 |
3,093 |
$16K |
| D2394 |
|
160 |
111 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
433 |
432 |
$11K |
| D0330 |
Panoramic radiographic image |
227 |
226 |
$10K |
| D2750 |
|
14 |
12 |
$9K |
| D1351 |
Sealant - per tooth |
252 |
83 |
$4K |
| D2954 |
|
30 |
24 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
14 |
$510.00 |
| D0270 |
|
12 |
12 |
$69.00 |
| D1330 |
|
15 |
14 |
$0.00 |
| D1999 |
|
512 |
417 |
$0.00 |