| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,576 |
3,485 |
$153K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,900 |
957 |
$139K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,265 |
1,138 |
$138K |
| D0120 |
Periodic oral evaluation - established patient |
5,293 |
5,183 |
$131K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,028 |
5,906 |
$130K |
| D1120 |
Prophylaxis - child |
2,836 |
2,787 |
$95K |
| D0274 |
Bitewings - four radiographic images |
1,944 |
1,903 |
$51K |
| D0330 |
Panoramic radiographic image |
1,344 |
1,318 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
3,074 |
2,973 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
944 |
922 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,290 |
1,750 |
$26K |
| D0272 |
Bitewings - two radiographic images |
835 |
824 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
631 |
607 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
207 |
206 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
71 |
47 |
$6K |
| D2332 |
|
21 |
12 |
$2K |
| D1351 |
Sealant - per tooth |
38 |
12 |
$1K |