| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,228 |
5,211 |
$257K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,870 |
1,855 |
$103K |
| D1110 |
Prophylaxis - adult |
3,241 |
3,225 |
$97K |
| D0330 |
Panoramic radiographic image |
2,093 |
2,083 |
$85K |
| D1120 |
Prophylaxis - child |
3,690 |
3,678 |
$73K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
147 |
134 |
$68K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,383 |
909 |
$50K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
513 |
381 |
$33K |
| D7111 |
|
436 |
254 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,713 |
6,685 |
$17K |
| D1351 |
Sealant - per tooth |
4,565 |
1,277 |
$12K |
| D2950 |
|
347 |
266 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,330 |
1,187 |
$7K |
| D9999 |
Unspecified adjunctive procedure, by report |
309 |
309 |
$7K |
| D0272 |
Bitewings - two radiographic images |
6,153 |
6,123 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
34 |
34 |
$5K |
| D1330 |
|
7,239 |
7,209 |
$3K |
| D3120 |
|
79 |
52 |
$2K |
| D0999 |
Unspecified diagnostic procedure, by report |
37 |
37 |
$740.00 |
| D0274 |
Bitewings - four radiographic images |
474 |
474 |
$0.00 |