| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,915 |
1,816 |
$71K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,181 |
724 |
$68K |
| D0330 |
Panoramic radiographic image |
1,244 |
1,183 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
3,021 |
2,861 |
$57K |
| D0274 |
Bitewings - four radiographic images |
2,312 |
2,182 |
$51K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
549 |
377 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,167 |
1,102 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
546 |
335 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
968 |
918 |
$15K |
| D1120 |
Prophylaxis - child |
563 |
530 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,469 |
1,390 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
284 |
257 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
719 |
310 |
$6K |
| D2394 |
|
50 |
37 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
68 |
47 |
$4K |
| D2160 |
|
20 |
16 |
$1K |
| D2331 |
|
25 |
12 |
$1K |
| D2140 |
|
18 |
13 |
$792.00 |
| D0272 |
Bitewings - two radiographic images |
55 |
54 |
$583.50 |