| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,244 |
5,906 |
$154K |
| D1110 |
Prophylaxis - adult |
3,597 |
3,431 |
$151K |
| D0330 |
Panoramic radiographic image |
3,598 |
3,448 |
$140K |
| D1120 |
Prophylaxis - child |
2,666 |
2,523 |
$123K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,083 |
1,278 |
$112K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,329 |
908 |
$75K |
| D0272 |
Bitewings - two radiographic images |
3,969 |
3,805 |
$59K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,890 |
3,700 |
$59K |
| D0140 |
Limited oral evaluation - problem focused |
1,564 |
1,477 |
$48K |
| D2332 |
|
562 |
320 |
$36K |
| D2331 |
|
481 |
306 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
264 |
260 |
$7K |
| D2335 |
|
48 |
25 |
$4K |
| D0274 |
Bitewings - four radiographic images |
87 |
77 |
$1K |