| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
2,525 |
2,167 |
$111K |
| D1110 |
Prophylaxis - adult |
3,821 |
3,268 |
$78K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,467 |
806 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,611 |
2,201 |
$35K |
| D1120 |
Prophylaxis - child |
943 |
831 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
2,485 |
2,173 |
$23K |
| D4355 |
|
294 |
252 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,987 |
4,307 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
188 |
100 |
$4K |
| D0274 |
Bitewings - four radiographic images |
2,327 |
2,021 |
$4K |
| D1351 |
Sealant - per tooth |
376 |
66 |
$4K |
| D9310 |
|
473 |
202 |
$2K |
| D1330 |
|
5,043 |
4,354 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
99 |
89 |
$1K |
| D9110 |
|
47 |
41 |
$639.96 |
| D0220 |
Intraoral - periapical first radiographic image |
164 |
142 |
$518.31 |