| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0350 |
|
6,178 |
3,783 |
$289K |
| D1110 |
Prophylaxis - adult |
2,912 |
2,876 |
$137K |
| D2750 |
|
166 |
103 |
$119K |
| D9110 |
|
1,808 |
1,578 |
$99K |
| D0120 |
Periodic oral evaluation - established patient |
2,809 |
2,775 |
$69K |
| D0330 |
Panoramic radiographic image |
774 |
768 |
$40K |
| D0274 |
Bitewings - four radiographic images |
1,129 |
1,117 |
$34K |
| D0460 |
|
1,151 |
1,087 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
1,717 |
1,640 |
$22K |
| D2950 |
|
131 |
82 |
$18K |
| D0383 |
|
114 |
114 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
446 |
426 |
$11K |
| D4910 |
|
135 |
130 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
179 |
179 |
$7K |
| D0380 |
|
47 |
47 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
33 |
26 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
118 |
114 |
$4K |
| D1206 |
Topical application of fluoride varnish |
135 |
135 |
$2K |