| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,498 |
2,408 |
$117K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,759 |
3,614 |
$103K |
| D0330 |
Panoramic radiographic image |
1,731 |
1,684 |
$92K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,130 |
902 |
$63K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,151 |
789 |
$49K |
| D0210 |
Intraoral - complete series of radiographic images |
806 |
772 |
$44K |
| D1120 |
Prophylaxis - child |
565 |
550 |
$29K |
| D5110 |
|
41 |
41 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
825 |
775 |
$25K |
| D0274 |
Bitewings - four radiographic images |
517 |
503 |
$16K |
| D1206 |
Topical application of fluoride varnish |
905 |
895 |
$15K |
| D2332 |
|
165 |
123 |
$11K |
| D2331 |
|
187 |
143 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
341 |
339 |
$9K |
| D5120 |
|
14 |
14 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,041 |
977 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
105 |
89 |
$5K |
| D2330 |
|
116 |
76 |
$5K |
| D2140 |
|
103 |
80 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
27 |
26 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
63 |
56 |
$818.85 |
| D0230 |
Intraoral - periapical each additional radiographic image |
38 |
24 |
$214.08 |