| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,788 |
1,752 |
$95K |
| D0330 |
Panoramic radiographic image |
694 |
685 |
$47K |
| D0272 |
Bitewings - two radiographic images |
1,305 |
1,291 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
1,353 |
1,334 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
645 |
639 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
682 |
636 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,136 |
928 |
$16K |
| D1120 |
Prophylaxis - child |
290 |
289 |
$15K |
| D1206 |
Topical application of fluoride varnish |
606 |
594 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
132 |
40 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,036 |
846 |
$10K |
| D7311 |
|
68 |
53 |
$7K |
| D0180 |
|
61 |
59 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
18 |
12 |
$2K |
| D0274 |
Bitewings - four radiographic images |
27 |
27 |
$803.00 |
| D1330 |
|
53 |
47 |
$0.00 |