| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,215 |
2,110 |
$97K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,317 |
891 |
$89K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,333 |
818 |
$67K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,642 |
1,557 |
$60K |
| D0140 |
Limited oral evaluation - problem focused |
1,774 |
1,659 |
$45K |
| D0210 |
Intraoral - complete series of radiographic images |
850 |
817 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
1,241 |
1,194 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
1,855 |
1,717 |
$17K |
| D0274 |
Bitewings - four radiographic images |
1,198 |
1,149 |
$16K |
| D4341 |
|
276 |
100 |
$12K |
| D0270 |
|
907 |
843 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
50 |
39 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
198 |
184 |
$4K |
| D2332 |
|
57 |
29 |
$3K |
| D1120 |
Prophylaxis - child |
167 |
156 |
$2K |
| D1999 |
|
180 |
162 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
267 |
253 |
$788.49 |