| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,535 |
1,209 |
$42K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
856 |
306 |
$35K |
| D0330 |
Panoramic radiographic image |
1,601 |
1,155 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
1,522 |
1,209 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,282 |
959 |
$21K |
| D0274 |
Bitewings - four radiographic images |
1,474 |
1,132 |
$18K |
| D8670 |
Periodic orthodontic treatment visit |
211 |
117 |
$13K |
| D1120 |
Prophylaxis - child |
785 |
621 |
$10K |
| D0340 |
|
296 |
236 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
521 |
442 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
190 |
70 |
$6K |
| D0272 |
Bitewings - two radiographic images |
531 |
400 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
497 |
358 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
104 |
46 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
71 |
60 |
$3K |
| D0350 |
|
296 |
239 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
29 |
12 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
262 |
174 |
$701.00 |
| D0470 |
|
39 |
28 |
$594.54 |