| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,524 |
6,219 |
$333K |
| D0120 |
Periodic oral evaluation - established patient |
8,353 |
8,004 |
$191K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,210 |
1,608 |
$165K |
| D1120 |
Prophylaxis - child |
3,115 |
3,016 |
$145K |
| D0274 |
Bitewings - four radiographic images |
3,906 |
3,748 |
$117K |
| D0330 |
Panoramic radiographic image |
2,202 |
2,082 |
$115K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,426 |
3,338 |
$93K |
| D8670 |
Periodic orthodontic treatment visit |
260 |
248 |
$60K |
| D1351 |
Sealant - per tooth |
1,233 |
338 |
$44K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
515 |
397 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
652 |
622 |
$26K |
| D0272 |
Bitewings - two radiographic images |
1,031 |
993 |
$25K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
266 |
233 |
$22K |
| D4341 |
|
89 |
32 |
$12K |
| D2740 |
Crown - porcelain/ceramic |
13 |
12 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
166 |
155 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
57 |
54 |
$2K |
| D2332 |
|
16 |
12 |
$2K |
| D2331 |
|
23 |
15 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
42 |
38 |
$882.00 |