| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,267 |
6,263 |
$228K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,990 |
1,993 |
$158K |
| D0120 |
Periodic oral evaluation - established patient |
5,440 |
5,438 |
$102K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,446 |
1,543 |
$95K |
| D0274 |
Bitewings - four radiographic images |
5,105 |
5,102 |
$93K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,383 |
978 |
$80K |
| D0210 |
Intraoral - complete series of radiographic images |
1,941 |
1,936 |
$68K |
| D0220 |
Intraoral - periapical first radiographic image |
6,666 |
6,585 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,268 |
2,265 |
$45K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,120 |
5,073 |
$45K |
| D2750 |
|
94 |
71 |
$35K |
| D1120 |
Prophylaxis - child |
1,172 |
1,172 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
1,707 |
1,683 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,046 |
1,046 |
$12K |
| D2394 |
|
91 |
66 |
$8K |
| D2332 |
|
57 |
39 |
$3K |
| D1206 |
Topical application of fluoride varnish |
87 |
87 |
$2K |
| D1351 |
Sealant - per tooth |
42 |
12 |
$2K |
| D9945 |
|
12 |
12 |
$1K |
| D1330 |
|
54 |
54 |
$0.00 |
| D1310 |
|
56 |
56 |
$0.00 |
| D1999 |
|
29 |
28 |
$0.00 |