| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,528 |
3,513 |
$112K |
| D9995 |
|
3,052 |
2,715 |
$68K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
931 |
397 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
3,001 |
2,987 |
$53K |
| D0330 |
Panoramic radiographic image |
1,578 |
1,573 |
$35K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
940 |
425 |
$34K |
| D0140 |
Limited oral evaluation - problem focused |
2,803 |
2,494 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
358 |
205 |
$24K |
| D4341 |
|
580 |
227 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
864 |
863 |
$17K |
| D2750 |
|
42 |
29 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
1,076 |
1,071 |
$14K |
| D0274 |
Bitewings - four radiographic images |
628 |
628 |
$10K |
| D0350 |
|
1,025 |
1,024 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
580 |
577 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
88 |
52 |
$5K |
| D9945 |
|
62 |
62 |
$5K |
| D2954 |
|
56 |
26 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
543 |
540 |
$5K |
| D0272 |
Bitewings - two radiographic images |
297 |
296 |
$3K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
13 |
12 |
$3K |
| D3320 |
|
24 |
16 |
$3K |
| D9310 |
|
155 |
153 |
$3K |
| D2330 |
|
91 |
40 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
124 |
123 |
$1K |
| D9996 |
|
93 |
92 |
$1K |
| D0250 |
|
27 |
27 |
$381.84 |
| D1120 |
Prophylaxis - child |
12 |
12 |
$313.65 |
| D4910 |
|
17 |
17 |
$165.06 |
| D0190 |
|
14 |
14 |
$0.00 |
| D0191 |
|
15 |
15 |
$0.00 |
| D0171 |
|
44 |
44 |
$0.00 |
| D9994 |
|
23 |
22 |
$0.00 |
| D0170 |
|
62 |
62 |
$0.00 |
| D1310 |
|
13 |
13 |
$0.00 |