| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,805 |
1,764 |
$68K |
| D0330 |
Panoramic radiographic image |
849 |
810 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
927 |
892 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
325 |
189 |
$25K |
| D0274 |
Bitewings - four radiographic images |
1,106 |
1,083 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
1,277 |
1,257 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
512 |
501 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
125 |
65 |
$8K |
| D1206 |
Topical application of fluoride varnish |
598 |
596 |
$8K |
| D1120 |
Prophylaxis - child |
333 |
330 |
$8K |
| D4355 |
|
76 |
76 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
763 |
703 |
$7K |
| D9994 |
|
1,372 |
1,341 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
461 |
334 |
$7K |
| D9630 |
|
326 |
316 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
251 |
246 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
304 |
234 |
$4K |
| D9920 |
|
36 |
35 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
12 |
$2K |
| D2950 |
|
18 |
12 |
$0.00 |