| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,460 |
4,325 |
$153K |
| D0140 |
Limited oral evaluation - problem focused |
4,639 |
4,330 |
$123K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,045 |
5,910 |
$114K |
| D0120 |
Periodic oral evaluation - established patient |
3,741 |
3,680 |
$87K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,251 |
754 |
$86K |
| D0274 |
Bitewings - four radiographic images |
2,966 |
2,906 |
$85K |
| D0210 |
Intraoral - complete series of radiographic images |
1,188 |
1,137 |
$73K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,875 |
1,609 |
$66K |
| D1120 |
Prophylaxis - child |
994 |
990 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
3,607 |
3,373 |
$39K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,939 |
1,881 |
$37K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
463 |
266 |
$28K |
| D0330 |
Panoramic radiographic image |
190 |
140 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
32 |
25 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
36 |
25 |
$2K |
| D2920 |
|
34 |
27 |
$742.56 |
| D1320 |
|
39 |
39 |
$177.81 |