| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,533 |
1,532 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
960 |
954 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,220 |
1,218 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
998 |
755 |
$11K |
| D1206 |
Topical application of fluoride varnish |
3,064 |
3,030 |
$10K |
| D4341 |
|
496 |
354 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
655 |
483 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,326 |
1,505 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
1,584 |
1,583 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
879 |
871 |
$5K |
| D1120 |
Prophylaxis - child |
746 |
745 |
$5K |
| D0274 |
Bitewings - four radiographic images |
1,276 |
1,274 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
2,053 |
2,040 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
202 |
192 |
$4K |
| D4910 |
|
339 |
339 |
$3K |
| D0603 |
|
1,534 |
1,530 |
$2K |
| D0602 |
|
1,160 |
1,157 |
$2K |
| D4342 |
|
119 |
80 |
$1K |
| D2332 |
|
36 |
28 |
$1K |
| D0270 |
|
327 |
327 |
$660.00 |
| D1354 |
|
2,126 |
515 |
$574.00 |
| D4346 |
|
47 |
47 |
$396.00 |
| D0330 |
Panoramic radiographic image |
366 |
364 |
$364.00 |
| D1320 |
|
202 |
200 |
$330.00 |
| D1330 |
|
3,735 |
3,666 |
$210.00 |
| D1310 |
|
3,635 |
3,575 |
$150.00 |
| D0191 |
|
16 |
16 |
$126.00 |
| D0272 |
Bitewings - two radiographic images |
39 |
39 |
$40.00 |
| D0240 |
|
22 |
12 |
$32.00 |