| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,103 |
3,049 |
$143K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,164 |
4,086 |
$111K |
| D1120 |
Prophylaxis - child |
1,564 |
1,541 |
$79K |
| D0274 |
Bitewings - four radiographic images |
2,398 |
2,359 |
$67K |
| D0330 |
Panoramic radiographic image |
1,296 |
1,283 |
$59K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
585 |
395 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,013 |
1,975 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
745 |
738 |
$19K |
| D0272 |
Bitewings - two radiographic images |
610 |
600 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
182 |
131 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
676 |
635 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
38 |
28 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
47 |
40 |
$2K |
| D9110 |
|
81 |
80 |
$2K |
| D1206 |
Topical application of fluoride varnish |
92 |
92 |
$2K |
| D2332 |
|
15 |
12 |
$1K |
| D2331 |
|
22 |
14 |
$995.50 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$386.10 |
| D1999 |
|
172 |
156 |
$0.00 |
| D9986 |
|
17 |
12 |
$0.00 |
| D9994 |
|
12 |
12 |
$0.00 |