| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,631 |
4,058 |
$338K |
| D0120 |
Periodic oral evaluation - established patient |
2,816 |
2,789 |
$90K |
| D4910 |
|
1,020 |
536 |
$82K |
| D9920 |
|
1,481 |
554 |
$73K |
| D0330 |
Panoramic radiographic image |
1,493 |
1,332 |
$64K |
| D1120 |
Prophylaxis - child |
1,258 |
1,087 |
$56K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
323 |
323 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
867 |
858 |
$29K |
| D2140 |
|
336 |
271 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
329 |
299 |
$25K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
306 |
226 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,356 |
1,355 |
$21K |
| D0251 |
|
858 |
850 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
105 |
97 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
366 |
322 |
$7K |
| D2330 |
|
20 |
13 |
$1K |
| D1206 |
Topical application of fluoride varnish |
14 |
14 |
$336.00 |