| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,734 |
2,730 |
$125K |
| D2332 |
|
1,240 |
356 |
$120K |
| D4341 |
|
1,311 |
480 |
$112K |
| D0120 |
Periodic oral evaluation - established patient |
3,901 |
3,890 |
$105K |
| D4910 |
|
1,429 |
1,422 |
$96K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,726 |
4,711 |
$87K |
| D0274 |
Bitewings - four radiographic images |
2,843 |
2,838 |
$79K |
| D0220 |
Intraoral - periapical first radiographic image |
4,241 |
3,963 |
$54K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
629 |
317 |
$43K |
| D0330 |
Panoramic radiographic image |
876 |
872 |
$42K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,996 |
3,132 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
839 |
822 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
766 |
765 |
$29K |
| D2335 |
|
142 |
68 |
$16K |
| D1120 |
Prophylaxis - child |
401 |
399 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
240 |
102 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
121 |
72 |
$10K |
| D1999 |
|
791 |
574 |
$2K |
| D0272 |
Bitewings - two radiographic images |
27 |
27 |
$414.00 |
| D0240 |
|
24 |
12 |
$328.00 |