| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,671 |
2,562 |
$87K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,284 |
806 |
$64K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,004 |
626 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
2,864 |
2,754 |
$47K |
| D0274 |
Bitewings - four radiographic images |
2,200 |
2,122 |
$42K |
| D0140 |
Limited oral evaluation - problem focused |
1,066 |
988 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,192 |
1,136 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
236 |
165 |
$12K |
| D2331 |
|
170 |
121 |
$10K |
| D1120 |
Prophylaxis - child |
429 |
409 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
112 |
106 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
80 |
58 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
740 |
669 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
126 |
124 |
$3K |
| D2160 |
|
17 |
13 |
$1K |
| D0272 |
Bitewings - two radiographic images |
120 |
113 |
$1K |
| D1320 |
|
74 |
69 |
$1K |
| D2140 |
|
20 |
13 |
$800.00 |
| D0330 |
Panoramic radiographic image |
13 |
12 |
$509.52 |
| D0230 |
Intraoral - periapical each additional radiographic image |
16 |
12 |
$60.00 |