| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,184 |
5,134 |
$90K |
| D0120 |
Periodic oral evaluation - established patient |
6,122 |
6,074 |
$87K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,441 |
5,849 |
$34K |
| D1120 |
Prophylaxis - child |
1,838 |
1,824 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,222 |
2,203 |
$27K |
| D1351 |
Sealant - per tooth |
1,135 |
112 |
$26K |
| D0330 |
Panoramic radiographic image |
1,500 |
1,481 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
6,175 |
6,049 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,070 |
2,053 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
364 |
180 |
$13K |
| D0272 |
Bitewings - two radiographic images |
2,718 |
2,700 |
$13K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
48 |
39 |
$11K |
| D0191 |
|
468 |
426 |
$7K |
| D0274 |
Bitewings - four radiographic images |
906 |
906 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
234 |
234 |
$5K |
| D9920 |
|
285 |
269 |
$4K |
| D1206 |
Topical application of fluoride varnish |
125 |
125 |
$2K |
| D9430 |
|
67 |
65 |
$850.00 |