| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,461 |
5,439 |
$220K |
| D0120 |
Periodic oral evaluation - established patient |
5,263 |
5,244 |
$109K |
| D0210 |
Intraoral - complete series of radiographic images |
1,638 |
1,637 |
$87K |
| D0140 |
Limited oral evaluation - problem focused |
1,589 |
1,562 |
$58K |
| D1120 |
Prophylaxis - child |
1,426 |
1,421 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,467 |
2,454 |
$50K |
| D1351 |
Sealant - per tooth |
2,526 |
373 |
$44K |
| D1206 |
Topical application of fluoride varnish |
1,723 |
1,716 |
$43K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
599 |
410 |
$26K |
| D0274 |
Bitewings - four radiographic images |
3,024 |
3,013 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
5,481 |
5,376 |
$21K |
| D0330 |
Panoramic radiographic image |
2,150 |
2,141 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,488 |
3,765 |
$17K |
| D2740 |
Crown - porcelain/ceramic |
17 |
13 |
$10K |
| D2954 |
|
29 |
25 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
49 |
30 |
$2K |
| D0272 |
Bitewings - two radiographic images |
321 |
321 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
39 |
30 |
$1K |
| D2999 |
|
81 |
75 |
$0.00 |
| D1999 |
|
1,290 |
1,246 |
$0.00 |