| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,455 |
5,246 |
$202K |
| D0120 |
Periodic oral evaluation - established patient |
8,030 |
7,669 |
$193K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,134 |
3,941 |
$67K |
| D0274 |
Bitewings - four radiographic images |
1,998 |
1,884 |
$62K |
| D1120 |
Prophylaxis - child |
2,055 |
1,987 |
$56K |
| D0330 |
Panoramic radiographic image |
904 |
847 |
$51K |
| D0140 |
Limited oral evaluation - problem focused |
1,049 |
925 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
638 |
613 |
$27K |
| D0272 |
Bitewings - two radiographic images |
803 |
755 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
939 |
893 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
125 |
79 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
76 |
41 |
$7K |
| D2140 |
|
73 |
36 |
$5K |
| D2394 |
|
22 |
14 |
$4K |
| D2160 |
|
16 |
12 |
$2K |
| D9110 |
|
41 |
38 |
$2K |