| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,341 |
4,290 |
$195K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,001 |
746 |
$132K |
| D0330 |
Panoramic radiographic image |
1,315 |
1,295 |
$94K |
| D0120 |
Periodic oral evaluation - established patient |
4,268 |
4,208 |
$61K |
| D1120 |
Prophylaxis - child |
1,478 |
1,453 |
$52K |
| D0210 |
Intraoral - complete series of radiographic images |
461 |
458 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,555 |
1,536 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,772 |
5,694 |
$12K |
| D1351 |
Sealant - per tooth |
1,117 |
210 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
454 |
224 |
$10K |
| D0274 |
Bitewings - four radiographic images |
4,624 |
4,561 |
$9K |
| D1330 |
|
5,767 |
5,690 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
79 |
37 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
5,671 |
5,557 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
251 |
238 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,559 |
5,458 |
$3K |
| D9999 |
Unspecified adjunctive procedure, by report |
80 |
80 |
$2K |
| D1999 |
|
21 |
21 |
$840.00 |
| D7111 |
|
22 |
14 |
$790.23 |
| D0603 |
|
101 |
101 |
$412.00 |
| D0601 |
|
92 |
91 |
$337.00 |
| D0272 |
Bitewings - two radiographic images |
465 |
453 |
$210.72 |