| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,441 |
5,371 |
$93K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,188 |
1,446 |
$92K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,331 |
1,542 |
$86K |
| D0120 |
Periodic oral evaluation - established patient |
5,101 |
5,039 |
$85K |
| D0210 |
Intraoral - complete series of radiographic images |
2,227 |
2,203 |
$57K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,639 |
962 |
$52K |
| D2750 |
|
221 |
167 |
$51K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,672 |
4,644 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,799 |
1,781 |
$40K |
| D2335 |
|
533 |
265 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
5,366 |
5,230 |
$20K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
61 |
57 |
$15K |
| D0272 |
Bitewings - two radiographic images |
3,051 |
2,999 |
$12K |
| D2954 |
|
224 |
178 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
589 |
560 |
$9K |
| D2332 |
|
169 |
108 |
$8K |
| D1120 |
Prophylaxis - child |
482 |
479 |
$7K |
| D0274 |
Bitewings - four radiographic images |
841 |
841 |
$7K |
| D2394 |
|
136 |
113 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
231 |
229 |
$2K |
| D1351 |
Sealant - per tooth |
165 |
14 |
$2K |
| D9110 |
|
97 |
96 |
$865.00 |
| D2331 |
|
16 |
14 |
$672.50 |
| D1999 |
|
271 |
235 |
$0.00 |
| D1330 |
|
12 |
12 |
$0.00 |