| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,960 |
2,861 |
$184K |
| D2752 |
|
175 |
137 |
$100K |
| D0120 |
Periodic oral evaluation - established patient |
2,418 |
2,340 |
$85K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
736 |
423 |
$64K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,364 |
1,301 |
$40K |
| D0140 |
Limited oral evaluation - problem focused |
731 |
678 |
$36K |
| D0210 |
Intraoral - complete series of radiographic images |
644 |
634 |
$36K |
| D1120 |
Prophylaxis - child |
583 |
550 |
$35K |
| D0330 |
Panoramic radiographic image |
1,095 |
1,032 |
$34K |
| D2950 |
|
208 |
163 |
$16K |
| D0274 |
Bitewings - four radiographic images |
890 |
844 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
477 |
449 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
180 |
107 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
105 |
63 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
663 |
580 |
$4K |