| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,663 |
3,562 |
$192K |
| D0120 |
Periodic oral evaluation - established patient |
6,949 |
6,742 |
$191K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,009 |
986 |
$139K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,448 |
735 |
$139K |
| D1120 |
Prophylaxis - child |
3,455 |
3,366 |
$121K |
| D0274 |
Bitewings - four radiographic images |
3,640 |
3,527 |
$116K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,055 |
6,859 |
$99K |
| D0220 |
Intraoral - periapical first radiographic image |
7,254 |
7,011 |
$84K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,800 |
6,718 |
$81K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,009 |
576 |
$77K |
| D0272 |
Bitewings - two radiographic images |
2,853 |
2,780 |
$62K |
| D1351 |
Sealant - per tooth |
900 |
213 |
$23K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
50 |
30 |
$5K |
| D0330 |
Panoramic radiographic image |
317 |
314 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
60 |
60 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
124 |
111 |
$4K |
| D0350 |
|
122 |
121 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
73 |
67 |
$1K |
| D0270 |
|
14 |
14 |
$63.70 |
| D0603 |
|
4,565 |
4,438 |
$0.00 |
| D0602 |
|
2,731 |
2,660 |
$0.00 |
| D0601 |
|
1,015 |
1,000 |
$0.00 |