| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,382 |
3,353 |
$119K |
| D9920 |
|
1,041 |
996 |
$101K |
| D0274 |
Bitewings - four radiographic images |
3,407 |
3,378 |
$90K |
| D0120 |
Periodic oral evaluation - established patient |
2,829 |
2,820 |
$67K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
867 |
598 |
$54K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
812 |
478 |
$42K |
| D1351 |
Sealant - per tooth |
1,437 |
273 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,492 |
1,470 |
$38K |
| D1206 |
Topical application of fluoride varnish |
1,852 |
1,849 |
$34K |
| D0330 |
Panoramic radiographic image |
785 |
779 |
$28K |
| D1120 |
Prophylaxis - child |
853 |
852 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
3,373 |
3,304 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,851 |
2,821 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
440 |
431 |
$18K |
| D1330 |
|
1,813 |
1,811 |
$14K |
| D1310 |
|
1,771 |
1,769 |
$14K |
| D0601 |
|
753 |
751 |
$5K |
| D0602 |
|
332 |
331 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
12 |
$847.05 |
| D0272 |
Bitewings - two radiographic images |
35 |
35 |
$555.36 |
| D0603 |
|
57 |
57 |
$320.00 |