| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0350 |
|
15,301 |
3,440 |
$141K |
| D0120 |
Periodic oral evaluation - established patient |
2,004 |
1,992 |
$115K |
| D1110 |
Prophylaxis - adult |
1,237 |
1,236 |
$105K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,586 |
1,586 |
$99K |
| D1120 |
Prophylaxis - child |
2,291 |
2,274 |
$91K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
932 |
445 |
$62K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
512 |
221 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,366 |
2,349 |
$26K |
| D0274 |
Bitewings - four radiographic images |
1,218 |
1,211 |
$25K |
| D0210 |
Intraoral - complete series of radiographic images |
502 |
501 |
$24K |
| D1206 |
Topical application of fluoride varnish |
1,322 |
1,321 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,725 |
1,713 |
$19K |
| D9430 |
|
402 |
370 |
$13K |
| D0330 |
Panoramic radiographic image |
380 |
380 |
$11K |
| D1351 |
Sealant - per tooth |
157 |
41 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
399 |
369 |
$3K |
| D0272 |
Bitewings - two radiographic images |
125 |
125 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
12 |
$1K |