| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,189 |
4,020 |
$156K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,080 |
765 |
$115K |
| D0120 |
Periodic oral evaluation - established patient |
4,496 |
4,332 |
$109K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,154 |
789 |
$91K |
| D0140 |
Limited oral evaluation - problem focused |
2,440 |
2,281 |
$83K |
| D0330 |
Panoramic radiographic image |
1,830 |
1,743 |
$75K |
| D0274 |
Bitewings - four radiographic images |
1,944 |
1,881 |
$59K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,194 |
1,130 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,863 |
2,763 |
$47K |
| D0220 |
Intraoral - periapical first radiographic image |
2,939 |
2,707 |
$42K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,580 |
1,437 |
$30K |
| D1120 |
Prophylaxis - child |
909 |
886 |
$24K |
| D0272 |
Bitewings - two radiographic images |
509 |
488 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
93 |
88 |
$6K |
| D0170 |
|
191 |
152 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
12 |
$2K |
| D1351 |
Sealant - per tooth |
51 |
13 |
$1K |
| D4355 |
|
13 |
13 |
$909.32 |