| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0350 |
|
22,824 |
5,274 |
$215K |
| D1110 |
Prophylaxis - adult |
1,969 |
1,959 |
$176K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,858 |
519 |
$148K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,804 |
1,797 |
$119K |
| D9430 |
|
3,032 |
2,739 |
$97K |
| D4341 |
|
1,186 |
297 |
$83K |
| D0210 |
Intraoral - complete series of radiographic images |
1,626 |
1,618 |
$78K |
| D0120 |
Periodic oral evaluation - established patient |
944 |
936 |
$76K |
| D4910 |
|
837 |
825 |
$64K |
| D1206 |
Topical application of fluoride varnish |
2,540 |
2,526 |
$46K |
| D2394 |
|
493 |
252 |
$41K |
| D1120 |
Prophylaxis - child |
796 |
792 |
$40K |
| D1320 |
|
2,651 |
2,636 |
$38K |
| D0330 |
Panoramic radiographic image |
1,150 |
1,144 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,278 |
984 |
$26K |
| D1351 |
Sealant - per tooth |
378 |
62 |
$14K |
| D2330 |
|
150 |
80 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
147 |
54 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
783 |
772 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
90 |
24 |
$5K |
| D1310 |
|
39 |
38 |
$2K |
| D2332 |
|
20 |
13 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
97 |
97 |
$1K |