| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,502 |
3,523 |
$162K |
| D0120 |
Periodic oral evaluation - established patient |
4,902 |
3,925 |
$86K |
| D0274 |
Bitewings - four radiographic images |
2,572 |
2,080 |
$71K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,200 |
2,487 |
$49K |
| D1120 |
Prophylaxis - child |
1,342 |
1,048 |
$35K |
| D0330 |
Panoramic radiographic image |
1,043 |
742 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,126 |
830 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
531 |
513 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
153 |
105 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
101 |
75 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
199 |
172 |
$6K |
| D4346 |
|
27 |
26 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
361 |
331 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
297 |
259 |
$3K |
| D0272 |
Bitewings - two radiographic images |
115 |
95 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
24 |
14 |
$1K |
| D1999 |
|
577 |
461 |
$490.00 |
| D0701 |
|
65 |
35 |
$0.00 |
| D1330 |
|
724 |
651 |
$0.00 |