| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,830 |
1,801 |
$81K |
| D0120 |
Periodic oral evaluation - established patient |
1,969 |
1,941 |
$51K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
574 |
324 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,263 |
2,215 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
3,880 |
3,746 |
$33K |
| D0274 |
Bitewings - four radiographic images |
2,425 |
2,371 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
743 |
718 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
473 |
236 |
$22K |
| D1206 |
Topical application of fluoride varnish |
360 |
357 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,620 |
3,044 |
$7K |
| D1999 |
|
560 |
501 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
107 |
66 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
259 |
254 |
$6K |
| D1120 |
Prophylaxis - child |
210 |
205 |
$5K |
| D2140 |
|
43 |
21 |
$2K |
| D0272 |
Bitewings - two radiographic images |
191 |
189 |
$2K |
| D0330 |
Panoramic radiographic image |
44 |
43 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$992.20 |
| D4341 |
|
38 |
17 |
$918.84 |
| D1351 |
Sealant - per tooth |
44 |
12 |
$791.28 |