| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,560 |
2,336 |
$106K |
| D0330 |
Panoramic radiographic image |
1,069 |
980 |
$62K |
| D0120 |
Periodic oral evaluation - established patient |
2,801 |
2,564 |
$56K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,618 |
1,494 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
802 |
660 |
$25K |
| D0274 |
Bitewings - four radiographic images |
767 |
709 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
336 |
173 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
174 |
104 |
$11K |
| D1120 |
Prophylaxis - child |
380 |
340 |
$9K |
| D0160 |
|
113 |
97 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
172 |
158 |
$5K |
| D2330 |
|
32 |
13 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
159 |
146 |
$1K |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$24.81 |