| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,605 |
2,442 |
$113K |
| D0140 |
Limited oral evaluation - problem focused |
2,028 |
1,909 |
$71K |
| D0120 |
Periodic oral evaluation - established patient |
2,916 |
2,768 |
$62K |
| D4341 |
|
265 |
80 |
$39K |
| D0330 |
Panoramic radiographic image |
469 |
432 |
$22K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
316 |
180 |
$19K |
| D0274 |
Bitewings - four radiographic images |
550 |
512 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
194 |
118 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
537 |
483 |
$15K |
| D1206 |
Topical application of fluoride varnish |
783 |
715 |
$12K |
| D4910 |
|
87 |
86 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
77 |
74 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
142 |
139 |
$2K |
| D2140 |
|
39 |
26 |
$2K |
| D1120 |
Prophylaxis - child |
111 |
101 |
$2K |
| D2160 |
|
23 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
80 |
77 |
$1K |