| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,126 |
1,980 |
$47K |
| D0140 |
Limited oral evaluation - problem focused |
2,364 |
2,194 |
$36K |
| D1206 |
Topical application of fluoride varnish |
2,230 |
2,092 |
$26K |
| D0210 |
Intraoral - complete series of radiographic images |
641 |
584 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
1,706 |
1,572 |
$19K |
| D0274 |
Bitewings - four radiographic images |
1,081 |
1,006 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
734 |
678 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,656 |
1,470 |
$10K |
| D0170 |
|
584 |
544 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
206 |
137 |
$6K |
| D0272 |
Bitewings - two radiographic images |
466 |
420 |
$4K |
| D1351 |
Sealant - per tooth |
398 |
92 |
$4K |
| D9110 |
|
88 |
75 |
$2K |
| D1120 |
Prophylaxis - child |
151 |
117 |
$2K |
| D2335 |
|
14 |
13 |
$836.28 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
24 |
16 |
$792.20 |
| D0230 |
Intraoral - periapical each additional radiographic image |
204 |
134 |
$770.03 |
| D4355 |
|
12 |
12 |
$750.53 |
| D0330 |
Panoramic radiographic image |
25 |
18 |
$547.50 |