| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,498 |
2,364 |
$92K |
| D0120 |
Periodic oral evaluation - established patient |
3,295 |
3,124 |
$61K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,104 |
2,012 |
$34K |
| D0330 |
Panoramic radiographic image |
767 |
731 |
$32K |
| D1120 |
Prophylaxis - child |
1,503 |
1,438 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
456 |
262 |
$27K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
402 |
271 |
$26K |
| D0274 |
Bitewings - four radiographic images |
1,157 |
1,091 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
404 |
388 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
47 |
45 |
$5K |
| D0272 |
Bitewings - two radiographic images |
298 |
283 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
569 |
530 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
48 |
36 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
43 |
38 |
$933.36 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
12 |
$842.00 |