| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,172 |
1,084 |
$45K |
| D0120 |
Periodic oral evaluation - established patient |
1,367 |
1,270 |
$25K |
| D0274 |
Bitewings - four radiographic images |
322 |
297 |
$10K |
| D1120 |
Prophylaxis - child |
330 |
301 |
$8K |
| D0330 |
Panoramic radiographic image |
128 |
112 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
156 |
136 |
$5K |
| D1206 |
Topical application of fluoride varnish |
238 |
214 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
212 |
186 |
$3K |
| D2331 |
|
19 |
12 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
18 |
12 |
$2K |
| D2330 |
|
20 |
14 |
$1K |
| D2140 |
|
17 |
13 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16 |
12 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$559.88 |