| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
9,554 |
9,495 |
$487K |
| D1120 |
Prophylaxis - child |
12,074 |
12,036 |
$455K |
| D0120 |
Periodic oral evaluation - established patient |
15,259 |
15,192 |
$449K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,888 |
5,743 |
$285K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,642 |
12,585 |
$262K |
| D1351 |
Sealant - per tooth |
7,211 |
1,929 |
$227K |
| D0272 |
Bitewings - two radiographic images |
9,329 |
9,259 |
$202K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,558 |
938 |
$166K |
| D1206 |
Topical application of fluoride varnish |
5,068 |
5,064 |
$144K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,452 |
5,337 |
$130K |
| D0220 |
Intraoral - periapical first radiographic image |
6,845 |
6,722 |
$101K |
| D0210 |
Intraoral - complete series of radiographic images |
1,079 |
1,069 |
$71K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
684 |
442 |
$52K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
398 |
269 |
$46K |
| D0140 |
Limited oral evaluation - problem focused |
735 |
731 |
$11K |
| D0330 |
Panoramic radiographic image |
151 |
151 |
$11K |
| D0145 |
Oral evaluation for a patient under three years of age |
18 |
18 |
$872.82 |
| D9986 |
|
260 |
256 |
$0.00 |