| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,066 |
969 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
1,171 |
1,082 |
$21K |
| D0330 |
Panoramic radiographic image |
695 |
611 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
608 |
563 |
$18K |
| D0274 |
Bitewings - four radiographic images |
659 |
589 |
$14K |
| D5110 |
|
45 |
42 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
437 |
391 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
290 |
135 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
151 |
82 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
172 |
131 |
$7K |
| D5120 |
|
27 |
24 |
$6K |
| D1206 |
Topical application of fluoride varnish |
406 |
360 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
695 |
620 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
499 |
209 |
$3K |
| D2394 |
|
21 |
12 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
30 |
14 |
$777.00 |
| D1120 |
Prophylaxis - child |
44 |
38 |
$621.00 |