| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,563 |
3,451 |
$190K |
| D9920 |
|
1,338 |
1,294 |
$89K |
| D0120 |
Periodic oral evaluation - established patient |
4,216 |
4,080 |
$53K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,293 |
868 |
$48K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
672 |
463 |
$40K |
| D0330 |
Panoramic radiographic image |
1,506 |
1,480 |
$33K |
| D1120 |
Prophylaxis - child |
2,091 |
2,022 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,772 |
1,714 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,268 |
5,091 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
462 |
327 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
132 |
100 |
$4K |
| D3120 |
|
852 |
437 |
$4K |
| D2335 |
|
38 |
24 |
$4K |
| D1330 |
|
5,844 |
5,658 |
$3K |
| D0274 |
Bitewings - four radiographic images |
3,345 |
3,255 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
343 |
332 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
4,975 |
4,816 |
$3K |
| D1351 |
Sealant - per tooth |
315 |
62 |
$2K |
| D0601 |
|
409 |
407 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,675 |
4,532 |
$2K |
| D0272 |
Bitewings - two radiographic images |
1,136 |
1,096 |
$2K |
| D0602 |
|
118 |
118 |
$690.00 |
| D7111 |
|
19 |
14 |
$268.48 |
| D0603 |
|
79 |
79 |
$215.00 |
| D1999 |
|
191 |
184 |
$4.00 |