| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,457 |
5,410 |
$244K |
| D0120 |
Periodic oral evaluation - established patient |
5,976 |
5,931 |
$157K |
| D1206 |
Topical application of fluoride varnish |
5,315 |
5,285 |
$119K |
| D0274 |
Bitewings - four radiographic images |
3,520 |
3,497 |
$112K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,681 |
1,140 |
$99K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,685 |
986 |
$77K |
| D0330 |
Panoramic radiographic image |
1,076 |
1,073 |
$66K |
| D1351 |
Sealant - per tooth |
3,187 |
630 |
$64K |
| D0220 |
Intraoral - periapical first radiographic image |
4,813 |
4,697 |
$64K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
702 |
455 |
$56K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,992 |
3,633 |
$42K |
| D1120 |
Prophylaxis - child |
1,195 |
1,188 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
1,175 |
1,142 |
$26K |
| D2721 |
|
17 |
14 |
$18K |
| D2140 |
|
256 |
115 |
$15K |
| D0272 |
Bitewings - two radiographic images |
446 |
445 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
277 |
201 |
$9K |
| D2950 |
|
45 |
38 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
242 |
241 |
$6K |
| D9944 |
|
12 |
12 |
$6K |
| D2331 |
|
27 |
13 |
$3K |
| D2330 |
|
27 |
12 |
$2K |
| D2160 |
|
15 |
12 |
$1K |
| D1999 |
|
78 |
69 |
$0.00 |
| D9985 |
|
79 |
71 |
$0.00 |