| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,122 |
5,970 |
$291K |
| D0120 |
Periodic oral evaluation - established patient |
7,689 |
7,518 |
$201K |
| D0274 |
Bitewings - four radiographic images |
4,716 |
4,591 |
$153K |
| D1206 |
Topical application of fluoride varnish |
6,335 |
6,156 |
$139K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,769 |
849 |
$106K |
| D0140 |
Limited oral evaluation - problem focused |
2,437 |
2,250 |
$75K |
| D1120 |
Prophylaxis - child |
2,504 |
2,444 |
$69K |
| D0220 |
Intraoral - periapical first radiographic image |
4,002 |
3,770 |
$49K |
| D1330 |
|
2,481 |
2,383 |
$45K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
414 |
244 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,312 |
1,259 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,270 |
2,033 |
$32K |
| D0330 |
Panoramic radiographic image |
577 |
534 |
$26K |
| D0350 |
|
422 |
409 |
$25K |
| D1310 |
|
290 |
290 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
381 |
220 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
73 |
73 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
136 |
94 |
$7K |
| D2160 |
|
36 |
24 |
$4K |
| D0272 |
Bitewings - two radiographic images |
173 |
164 |
$3K |
| D1351 |
Sealant - per tooth |
229 |
54 |
$2K |
| D0270 |
|
14 |
14 |
$125.61 |
| D1999 |
|
29 |
27 |
$0.00 |