| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,727 |
4,504 |
$234K |
| D0120 |
Periodic oral evaluation - established patient |
5,717 |
5,447 |
$125K |
| D9110 |
|
2,020 |
1,880 |
$75K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,284 |
572 |
$74K |
| D0330 |
Panoramic radiographic image |
1,080 |
1,031 |
$63K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,584 |
1,527 |
$43K |
| D1120 |
Prophylaxis - child |
901 |
869 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
2,770 |
2,604 |
$41K |
| D0272 |
Bitewings - two radiographic images |
1,927 |
1,834 |
$37K |
| D0274 |
Bitewings - four radiographic images |
943 |
893 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,397 |
1,205 |
$17K |
| D2954 |
|
26 |
16 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
47 |
37 |
$3K |
| D1351 |
Sealant - per tooth |
82 |
17 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
31 |
24 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
26 |
25 |
$1K |
| D2330 |
|
26 |
14 |
$1K |
| D9215 |
|
72 |
58 |
$0.00 |