| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,683 |
2,502 |
$70K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
983 |
538 |
$58K |
| D0330 |
Panoramic radiographic image |
910 |
873 |
$48K |
| D0274 |
Bitewings - four radiographic images |
1,706 |
1,598 |
$44K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
592 |
337 |
$41K |
| D1110 |
Prophylaxis - adult |
855 |
787 |
$35K |
| D5110 |
|
53 |
53 |
$34K |
| D1120 |
Prophylaxis - child |
742 |
675 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
963 |
874 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
2,794 |
2,515 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,580 |
1,449 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,222 |
1,108 |
$18K |
| D1351 |
Sealant - per tooth |
504 |
108 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
468 |
429 |
$9K |
| D9110 |
|
151 |
143 |
$9K |
| D2332 |
|
91 |
57 |
$6K |
| D4341 |
|
68 |
24 |
$5K |
| D2331 |
|
55 |
30 |
$4K |
| D2394 |
|
36 |
29 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
43 |
29 |
$2K |
| D0272 |
Bitewings - two radiographic images |
42 |
39 |
$676.90 |
| D1206 |
Topical application of fluoride varnish |
29 |
28 |
$468.75 |