| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,355 |
2,974 |
$137K |
| D0330 |
Panoramic radiographic image |
1,624 |
1,436 |
$85K |
| D0120 |
Periodic oral evaluation - established patient |
4,113 |
3,633 |
$84K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,719 |
1,486 |
$52K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,757 |
2,407 |
$49K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
522 |
363 |
$42K |
| D1120 |
Prophylaxis - child |
1,641 |
1,424 |
$38K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
447 |
299 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
466 |
262 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
1,087 |
945 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
227 |
87 |
$15K |
| D2335 |
|
76 |
50 |
$7K |
| D2331 |
|
92 |
51 |
$6K |
| D2394 |
|
55 |
39 |
$5K |
| D0272 |
Bitewings - two radiographic images |
308 |
253 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
342 |
268 |
$2K |
| D2160 |
|
20 |
12 |
$1K |