| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,620 |
2,600 |
$183K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,736 |
2,724 |
$149K |
| D0120 |
Periodic oral evaluation - established patient |
3,315 |
3,293 |
$145K |
| D1120 |
Prophylaxis - child |
2,739 |
2,726 |
$93K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,456 |
732 |
$86K |
| D0210 |
Intraoral - complete series of radiographic images |
2,151 |
2,139 |
$83K |
| D1351 |
Sealant - per tooth |
3,505 |
784 |
$79K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,385 |
3,874 |
$49K |
| D9999 |
Unspecified adjunctive procedure, by report |
397 |
377 |
$47K |
| D1206 |
Topical application of fluoride varnish |
2,357 |
2,344 |
$44K |
| D9430 |
|
1,357 |
1,294 |
$37K |
| D0272 |
Bitewings - two radiographic images |
2,556 |
2,543 |
$22K |
| D1320 |
|
1,062 |
1,057 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,162 |
1,146 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
109 |
59 |
$6K |
| D0274 |
Bitewings - four radiographic images |
339 |
339 |
$4K |
| D2160 |
|
58 |
37 |
$4K |
| D0330 |
Panoramic radiographic image |
103 |
103 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
14 |
$1K |
| D1999 |
|
408 |
404 |
$500.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
15 |
15 |
$222.00 |