| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,908 |
6,606 |
$289K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,486 |
2,620 |
$284K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,510 |
1,880 |
$177K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,999 |
3,697 |
$129K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,933 |
7,592 |
$129K |
| D0120 |
Periodic oral evaluation - established patient |
4,629 |
4,545 |
$121K |
| D0274 |
Bitewings - four radiographic images |
7,335 |
6,975 |
$92K |
| D0220 |
Intraoral - periapical first radiographic image |
8,349 |
7,846 |
$70K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
785 |
596 |
$58K |
| D0140 |
Limited oral evaluation - problem focused |
1,599 |
1,441 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,042 |
7,315 |
$30K |
| D4341 |
|
670 |
204 |
$25K |
| D1351 |
Sealant - per tooth |
1,158 |
308 |
$22K |
| D0330 |
Panoramic radiographic image |
429 |
400 |
$19K |
| D1120 |
Prophylaxis - child |
854 |
825 |
$18K |
| D1999 |
|
4,813 |
3,913 |
$18K |
| D9110 |
|
288 |
261 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
135 |
70 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
42 |
40 |
$2K |
| D2331 |
|
36 |
26 |
$2K |
| D2140 |
|
23 |
13 |
$846.73 |
| D0272 |
Bitewings - two radiographic images |
37 |
36 |
$360.15 |
| D9991 |
|
120 |
100 |
$0.00 |