| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,188 |
2,170 |
$72K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,195 |
663 |
$70K |
| D1110 |
Prophylaxis - adult |
1,396 |
1,388 |
$55K |
| D0330 |
Panoramic radiographic image |
587 |
585 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,466 |
2,441 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
714 |
709 |
$32K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
121 |
90 |
$10K |
| D1120 |
Prophylaxis - child |
1,411 |
1,394 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
263 |
161 |
$8K |
| D1351 |
Sealant - per tooth |
675 |
161 |
$8K |
| D0274 |
Bitewings - four radiographic images |
1,341 |
1,325 |
$4K |
| D1330 |
|
2,946 |
2,918 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
119 |
118 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,627 |
2,230 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
2,516 |
2,467 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
298 |
292 |
$2K |
| D9110 |
|
86 |
83 |
$2K |
| D1999 |
|
23 |
23 |
$920.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
29 |
29 |
$725.00 |
| D1206 |
Topical application of fluoride varnish |
430 |
429 |
$565.10 |
| D0999 |
Unspecified diagnostic procedure, by report |
12 |
12 |
$240.00 |
| D0272 |
Bitewings - two radiographic images |
92 |
90 |
$24.00 |
| D0603 |
|
31 |
31 |
$0.00 |
| D0601 |
|
46 |
45 |
$0.00 |