| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
7,390 |
7,050 |
$284K |
| D0330 |
Panoramic radiographic image |
4,782 |
4,536 |
$245K |
| D0120 |
Periodic oral evaluation - established patient |
8,159 |
7,792 |
$161K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,699 |
1,164 |
$121K |
| D0140 |
Limited oral evaluation - problem focused |
4,533 |
4,142 |
$112K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,308 |
3,152 |
$97K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,050 |
4,794 |
$91K |
| D2394 |
|
1,031 |
744 |
$84K |
| D1120 |
Prophylaxis - child |
3,216 |
3,061 |
$76K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
767 |
544 |
$47K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
519 |
358 |
$33K |
| D2335 |
|
242 |
126 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
794 |
710 |
$5K |
| D2160 |
|
42 |
26 |
$3K |
| D2330 |
|
26 |
13 |
$3K |
| D2161 |
|
15 |
12 |
$1K |