| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0350 |
|
6,587 |
2,573 |
$403K |
| D1110 |
Prophylaxis - adult |
2,491 |
2,470 |
$115K |
| D0120 |
Periodic oral evaluation - established patient |
2,276 |
2,259 |
$54K |
| D9110 |
|
721 |
541 |
$38K |
| D0330 |
Panoramic radiographic image |
573 |
572 |
$30K |
| D0274 |
Bitewings - four radiographic images |
812 |
804 |
$24K |
| D1206 |
Topical application of fluoride varnish |
969 |
956 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,301 |
1,269 |
$16K |
| D1354 |
|
194 |
68 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
389 |
382 |
$6K |
| D0180 |
|
110 |
110 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
29 |
28 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
93 |
93 |
$4K |
| D0460 |
|
126 |
119 |
$3K |
| D0412 |
|
180 |
176 |
$3K |
| D1120 |
Prophylaxis - child |
83 |
83 |
$3K |
| D0383 |
|
18 |
18 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
12 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
24 |
24 |
$793.44 |