| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,270 |
3,113 |
$168K |
| D0120 |
Periodic oral evaluation - established patient |
3,592 |
3,384 |
$83K |
| D8670 |
Periodic orthodontic treatment visit |
438 |
329 |
$73K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
979 |
591 |
$70K |
| D0210 |
Intraoral - complete series of radiographic images |
829 |
798 |
$56K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,924 |
1,814 |
$52K |
| D0274 |
Bitewings - four radiographic images |
1,145 |
1,101 |
$41K |
| D1120 |
Prophylaxis - child |
868 |
832 |
$40K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
571 |
351 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
637 |
612 |
$26K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
275 |
193 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
537 |
487 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
984 |
934 |
$15K |
| D4342 |
|
109 |
46 |
$9K |
| D1351 |
Sealant - per tooth |
233 |
56 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
623 |
556 |
$8K |
| D4341 |
|
66 |
20 |
$7K |
| D2331 |
|
81 |
54 |
$6K |
| D0330 |
Panoramic radiographic image |
64 |
64 |
$3K |
| D9110 |
|
77 |
69 |
$3K |
| D2330 |
|
38 |
24 |
$3K |
| D2332 |
|
20 |
12 |
$2K |
| D1999 |
|
16 |
14 |
$0.00 |