| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,372 |
4,137 |
$212K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,412 |
1,152 |
$180K |
| D0120 |
Periodic oral evaluation - established patient |
4,719 |
4,480 |
$120K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,248 |
4,074 |
$77K |
| D0274 |
Bitewings - four radiographic images |
2,191 |
2,075 |
$68K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
391 |
336 |
$65K |
| D1120 |
Prophylaxis - child |
1,816 |
1,740 |
$63K |
| D0220 |
Intraoral - periapical first radiographic image |
2,619 |
2,370 |
$47K |
| D0140 |
Limited oral evaluation - problem focused |
884 |
831 |
$36K |
| D1206 |
Topical application of fluoride varnish |
1,381 |
1,266 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,832 |
1,167 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
325 |
308 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
430 |
399 |
$17K |
| D4910 |
|
123 |
121 |
$10K |
| D0330 |
Panoramic radiographic image |
137 |
135 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
91 |
78 |
$8K |
| D1999 |
|
21 |
20 |
$0.00 |
| D4999 |
|
87 |
80 |
$0.00 |