| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,455 |
1,295 |
$74K |
| D0120 |
Periodic oral evaluation - established patient |
2,340 |
2,098 |
$55K |
| D0274 |
Bitewings - four radiographic images |
1,327 |
1,187 |
$46K |
| D1120 |
Prophylaxis - child |
984 |
918 |
$44K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,302 |
1,211 |
$29K |
| D1206 |
Topical application of fluoride varnish |
1,075 |
931 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,398 |
1,222 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
151 |
91 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,056 |
913 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
111 |
65 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
162 |
146 |
$6K |
| D0330 |
Panoramic radiographic image |
107 |
96 |
$5K |
| D9110 |
|
60 |
59 |
$4K |
| D4341 |
|
31 |
12 |
$4K |
| D1351 |
Sealant - per tooth |
90 |
26 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
51 |
43 |
$2K |
| D0272 |
Bitewings - two radiographic images |
14 |
13 |
$330.00 |
| D1999 |
|
789 |
638 |
$0.00 |