| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,562 |
2,515 |
$122K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,269 |
733 |
$69K |
| D0330 |
Panoramic radiographic image |
855 |
842 |
$67K |
| D1120 |
Prophylaxis - child |
1,592 |
1,577 |
$58K |
| D0120 |
Periodic oral evaluation - established patient |
3,498 |
3,440 |
$30K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
951 |
557 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
673 |
667 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
68 |
51 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,238 |
4,175 |
$8K |
| D1330 |
|
4,239 |
4,174 |
$7K |
| D0274 |
Bitewings - four radiographic images |
2,592 |
2,545 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
16 |
16 |
$2K |
| D0272 |
Bitewings - two radiographic images |
1,202 |
1,187 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
62 |
59 |
$931.93 |
| D0601 |
|
290 |
290 |
$275.00 |
| D0220 |
Intraoral - periapical first radiographic image |
174 |
162 |
$52.59 |