| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,198 |
4,085 |
$224K |
| D0274 |
Bitewings - four radiographic images |
4,408 |
4,297 |
$162K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,144 |
1,067 |
$141K |
| D0120 |
Periodic oral evaluation - established patient |
4,855 |
4,739 |
$120K |
| D0220 |
Intraoral - periapical first radiographic image |
6,802 |
6,568 |
$111K |
| D1120 |
Prophylaxis - child |
2,163 |
2,122 |
$110K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,123 |
2,076 |
$93K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,548 |
5,528 |
$88K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,796 |
2,743 |
$79K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
825 |
554 |
$70K |
| D0140 |
Limited oral evaluation - problem focused |
1,777 |
1,724 |
$69K |
| D0210 |
Intraoral - complete series of radiographic images |
789 |
772 |
$56K |
| D1351 |
Sealant - per tooth |
1,033 |
331 |
$42K |
| D2740 |
Crown - porcelain/ceramic |
20 |
14 |
$14K |
| D0272 |
Bitewings - two radiographic images |
165 |
165 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
22 |
13 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
12 |
$1K |