| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,132 |
2,052 |
$99K |
| D1120 |
Prophylaxis - child |
1,737 |
1,669 |
$81K |
| D0330 |
Panoramic radiographic image |
1,820 |
1,779 |
$77K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,693 |
2,603 |
$69K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,078 |
742 |
$61K |
| D0274 |
Bitewings - four radiographic images |
1,964 |
1,899 |
$51K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,845 |
2,728 |
$42K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
757 |
543 |
$34K |
| D0140 |
Limited oral evaluation - problem focused |
532 |
516 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
769 |
736 |
$6K |
| D0272 |
Bitewings - two radiographic images |
188 |
185 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
43 |
36 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
84 |
82 |
$2K |
| D2332 |
|
14 |
12 |
$1K |
| D9110 |
|
15 |
15 |
$929.25 |
| D0230 |
Intraoral - periapical each additional radiographic image |
71 |
32 |
$576.04 |