| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,989 |
5,876 |
$221K |
| D0120 |
Periodic oral evaluation - established patient |
7,530 |
7,341 |
$130K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,075 |
852 |
$74K |
| D0210 |
Intraoral - complete series of radiographic images |
1,423 |
1,378 |
$69K |
| D0140 |
Limited oral evaluation - problem focused |
2,480 |
2,434 |
$64K |
| D1120 |
Prophylaxis - child |
2,229 |
2,147 |
$57K |
| D0272 |
Bitewings - two radiographic images |
2,734 |
2,669 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,908 |
2,777 |
$41K |
| D0330 |
Panoramic radiographic image |
858 |
844 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,073 |
1,054 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
456 |
314 |
$24K |
| D1351 |
Sealant - per tooth |
316 |
43 |
$6K |
| D2330 |
|
103 |
66 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
477 |
468 |
$4K |
| D0274 |
Bitewings - four radiographic images |
186 |
177 |
$4K |
| D1999 |
|
73 |
53 |
$0.00 |