| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,778 |
2,708 |
$98K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,665 |
2,607 |
$61K |
| D0330 |
Panoramic radiographic image |
1,634 |
1,595 |
$57K |
| D0274 |
Bitewings - four radiographic images |
2,632 |
2,573 |
$57K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
827 |
576 |
$41K |
| D1120 |
Prophylaxis - child |
991 |
968 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,951 |
1,918 |
$25K |
| D9110 |
|
1,054 |
1,019 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
1,111 |
1,081 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
249 |
194 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,309 |
1,281 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
142 |
104 |
$6K |
| D0272 |
Bitewings - two radiographic images |
233 |
226 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
638 |
343 |
$3K |
| D2394 |
|
17 |
14 |
$1K |
| D1351 |
Sealant - per tooth |
56 |
13 |
$982.80 |
| D2332 |
|
13 |
12 |
$957.00 |
| D2335 |
|
14 |
13 |
$842.40 |
| D9986 |
|
1,507 |
1,336 |
$0.00 |
| D9987 |
|
637 |
569 |
$0.00 |