| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,157 |
3,774 |
$140K |
| D0120 |
Periodic oral evaluation - established patient |
4,995 |
4,470 |
$88K |
| D0274 |
Bitewings - four radiographic images |
2,400 |
2,191 |
$45K |
| D1206 |
Topical application of fluoride varnish |
2,788 |
2,489 |
$43K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
832 |
438 |
$40K |
| D1120 |
Prophylaxis - child |
1,911 |
1,745 |
$38K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
602 |
396 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
457 |
415 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
785 |
710 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
550 |
532 |
$14K |
| D0330 |
Panoramic radiographic image |
373 |
360 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
2,196 |
1,935 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,762 |
743 |
$7K |
| D0272 |
Bitewings - two radiographic images |
284 |
273 |
$3K |
| D2330 |
|
55 |
27 |
$3K |
| D1351 |
Sealant - per tooth |
44 |
14 |
$880.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
17 |
12 |
$864.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
12 |
$715.00 |