| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,469 |
3,451 |
$192K |
| D0120 |
Periodic oral evaluation - established patient |
3,444 |
3,432 |
$116K |
| D1206 |
Topical application of fluoride varnish |
3,704 |
3,679 |
$109K |
| D0274 |
Bitewings - four radiographic images |
2,512 |
2,494 |
$100K |
| D0330 |
Panoramic radiographic image |
1,236 |
1,226 |
$89K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
690 |
356 |
$59K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,351 |
1,341 |
$52K |
| D1120 |
Prophylaxis - child |
1,363 |
1,362 |
$52K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
628 |
395 |
$48K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
589 |
332 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
941 |
923 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
1,605 |
1,556 |
$24K |
| D1330 |
|
416 |
415 |
$11K |
| D0272 |
Bitewings - two radiographic images |
299 |
298 |
$10K |
| D2140 |
|
213 |
123 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
342 |
205 |
$4K |
| D2330 |
|
31 |
12 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
13 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
201 |
201 |
$0.00 |