| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,658 |
1,557 |
$65K |
| D0120 |
Periodic oral evaluation - established patient |
2,159 |
2,023 |
$52K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
493 |
350 |
$33K |
| D1110 |
Prophylaxis - adult |
1,007 |
921 |
$29K |
| D9110 |
|
378 |
353 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
742 |
707 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,905 |
1,719 |
$14K |
| D1351 |
Sealant - per tooth |
181 |
109 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
674 |
637 |
$14K |
| D0274 |
Bitewings - four radiographic images |
836 |
779 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
2,372 |
2,193 |
$13K |
| D2740 |
Crown - porcelain/ceramic |
39 |
27 |
$10K |
| D8670 |
Periodic orthodontic treatment visit |
30 |
30 |
$6K |
| D0272 |
Bitewings - two radiographic images |
537 |
510 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
307 |
278 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
79 |
58 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
160 |
144 |
$2K |
| D0330 |
Panoramic radiographic image |
52 |
51 |
$1K |