| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,460 |
1,440 |
$53K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
749 |
219 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,187 |
1,167 |
$32K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
416 |
168 |
$25K |
| D9630 |
|
1,307 |
1,291 |
$24K |
| D0274 |
Bitewings - four radiographic images |
997 |
975 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
2,267 |
2,073 |
$20K |
| D0330 |
Panoramic radiographic image |
472 |
466 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
724 |
716 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,555 |
1,362 |
$14K |
| D1206 |
Topical application of fluoride varnish |
616 |
606 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
583 |
495 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
739 |
738 |
$10K |
| D1120 |
Prophylaxis - child |
221 |
221 |
$7K |
| D2950 |
|
83 |
64 |
$4K |
| D9110 |
|
12 |
12 |
$581.16 |
| D9310 |
|
35 |
35 |
$0.00 |