| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
7,884 |
7,882 |
$210K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,680 |
1,587 |
$140K |
| D2335 |
|
975 |
630 |
$106K |
| D0120 |
Periodic oral evaluation - established patient |
7,535 |
7,532 |
$96K |
| D0274 |
Bitewings - four radiographic images |
6,253 |
6,253 |
$87K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,074 |
1,421 |
$84K |
| D0210 |
Intraoral - complete series of radiographic images |
5,906 |
5,879 |
$68K |
| D0220 |
Intraoral - periapical first radiographic image |
7,266 |
7,257 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,940 |
4,932 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,139 |
2,139 |
$45K |
| D2332 |
|
613 |
362 |
$37K |
| D1120 |
Prophylaxis - child |
1,467 |
1,467 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,025 |
3,023 |
$25K |
| D9944 |
|
107 |
107 |
$11K |
| D2331 |
|
63 |
55 |
$5K |
| D1351 |
Sealant - per tooth |
87 |
28 |
$4K |
| D5761 |
|
25 |
25 |
$3K |
| D9110 |
|
14 |
14 |
$284.28 |