| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
10,875 |
10,808 |
$505K |
| D0120 |
Periodic oral evaluation - established patient |
9,656 |
9,607 |
$251K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,784 |
2,862 |
$245K |
| D0140 |
Limited oral evaluation - problem focused |
4,182 |
4,116 |
$190K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,690 |
1,723 |
$166K |
| D0210 |
Intraoral - complete series of radiographic images |
3,268 |
3,254 |
$153K |
| D1120 |
Prophylaxis - child |
2,329 |
2,318 |
$109K |
| D2752 |
|
164 |
119 |
$94K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,425 |
3,415 |
$89K |
| D1206 |
Topical application of fluoride varnish |
1,862 |
1,861 |
$60K |
| D0274 |
Bitewings - four radiographic images |
4,419 |
4,399 |
$52K |
| D0220 |
Intraoral - periapical first radiographic image |
7,100 |
6,965 |
$34K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
778 |
579 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,654 |
4,709 |
$16K |
| D2332 |
|
162 |
88 |
$11K |
| D2394 |
|
107 |
76 |
$9K |
| D2335 |
|
91 |
55 |
$8K |
| D9920 |
|
286 |
283 |
$5K |
| D0270 |
|
830 |
791 |
$4K |
| D0330 |
Panoramic radiographic image |
277 |
274 |
$3K |
| D0272 |
Bitewings - two radiographic images |
196 |
196 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
59 |
59 |
$1K |
| D2331 |
|
14 |
12 |
$955.50 |
| D2950 |
|
14 |
14 |
$803.50 |
| D1999 |
|
142 |
139 |
$0.00 |