| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2752 |
|
467 |
320 |
$228K |
| D1110 |
Prophylaxis - adult |
3,170 |
3,154 |
$98K |
| D0120 |
Periodic oral evaluation - established patient |
2,660 |
2,641 |
$65K |
| D0140 |
Limited oral evaluation - problem focused |
1,491 |
1,457 |
$64K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
945 |
546 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,053 |
1,051 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
4,709 |
4,605 |
$23K |
| D0274 |
Bitewings - four radiographic images |
2,727 |
2,716 |
$22K |
| D0330 |
Panoramic radiographic image |
466 |
465 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,685 |
3,651 |
$11K |
| D1120 |
Prophylaxis - child |
244 |
244 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
543 |
543 |
$10K |
| D0272 |
Bitewings - two radiographic images |
680 |
674 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
125 |
85 |
$6K |
| D2952 |
|
49 |
39 |
$6K |
| D2950 |
|
71 |
42 |
$4K |
| D2332 |
|
25 |
13 |
$1K |
| D2394 |
|
16 |
12 |
$1K |