| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
1,140 |
1,137 |
$80K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,809 |
1,110 |
$72K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
921 |
668 |
$66K |
| D1110 |
Prophylaxis - adult |
2,725 |
2,717 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
1,740 |
1,736 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,838 |
1,834 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,342 |
784 |
$22K |
| D0330 |
Panoramic radiographic image |
408 |
407 |
$20K |
| D1120 |
Prophylaxis - child |
687 |
685 |
$8K |
| D1351 |
Sealant - per tooth |
2,259 |
699 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,476 |
3,466 |
$5K |
| D1330 |
|
3,463 |
3,453 |
$3K |
| D0272 |
Bitewings - two radiographic images |
1,951 |
1,946 |
$2K |
| D2332 |
|
34 |
26 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
1,881 |
1,874 |
$797.38 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,854 |
1,781 |
$777.39 |
| D0601 |
|
1,118 |
1,115 |
$182.81 |
| D0603 |
|
25 |
25 |
$45.00 |
| D0602 |
|
25 |
25 |
$0.00 |
| D9986 |
|
24 |
24 |
$0.00 |