| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,640 |
4,634 |
$205K |
| D0120 |
Periodic oral evaluation - established patient |
3,417 |
3,414 |
$78K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,030 |
722 |
$67K |
| D0220 |
Intraoral - periapical first radiographic image |
6,165 |
5,919 |
$65K |
| D0274 |
Bitewings - four radiographic images |
2,712 |
2,709 |
$62K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,357 |
2,355 |
$55K |
| D0330 |
Panoramic radiographic image |
1,796 |
1,795 |
$52K |
| D0350 |
|
3,799 |
3,795 |
$39K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,380 |
3,330 |
$28K |
| D1120 |
Prophylaxis - child |
663 |
661 |
$22K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
30 |
25 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
1,124 |
1,076 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
787 |
785 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
119 |
98 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
88 |
63 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
486 |
439 |
$3K |
| D0272 |
Bitewings - two radiographic images |
124 |
124 |
$2K |
| D1330 |
|
2,415 |
2,409 |
$0.00 |
| D1310 |
|
2,416 |
2,410 |
$0.00 |
| D0431 |
|
1,658 |
1,654 |
$0.00 |
| D1999 |
|
406 |
387 |
$0.00 |