| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,137 |
4,137 |
$261K |
| D0120 |
Periodic oral evaluation - established patient |
3,052 |
3,052 |
$104K |
| D0210 |
Intraoral - complete series of radiographic images |
1,113 |
1,110 |
$80K |
| D1320 |
|
2,686 |
2,685 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,692 |
1,692 |
$53K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
597 |
356 |
$42K |
| D0274 |
Bitewings - four radiographic images |
1,617 |
1,617 |
$40K |
| D0140 |
Limited oral evaluation - problem focused |
1,426 |
1,424 |
$38K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
225 |
133 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
331 |
196 |
$17K |
| D0330 |
Panoramic radiographic image |
233 |
233 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,445 |
1,430 |
$12K |
| D2331 |
|
92 |
64 |
$9K |
| D1120 |
Prophylaxis - child |
117 |
117 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
676 |
671 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
297 |
297 |
$4K |
| D2332 |
|
24 |
12 |
$3K |
| D2330 |
|
16 |
12 |
$1K |