| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,289 |
1,164 |
$61K |
| D0120 |
Periodic oral evaluation - established patient |
1,897 |
1,768 |
$43K |
| D1206 |
Topical application of fluoride varnish |
1,533 |
1,424 |
$32K |
| D1120 |
Prophylaxis - child |
917 |
868 |
$28K |
| D0274 |
Bitewings - four radiographic images |
584 |
526 |
$19K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
172 |
110 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
244 |
211 |
$8K |
| D0330 |
Panoramic radiographic image |
117 |
104 |
$6K |
| D0272 |
Bitewings - two radiographic images |
232 |
214 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
88 |
81 |
$3K |
| D2160 |
|
23 |
13 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
18 |
13 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
16 |
13 |
$944.99 |