| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,368 |
3,364 |
$144K |
| D0120 |
Periodic oral evaluation - established patient |
4,309 |
4,303 |
$100K |
| D0274 |
Bitewings - four radiographic images |
2,924 |
2,923 |
$62K |
| D0330 |
Panoramic radiographic image |
1,454 |
1,452 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
2,570 |
2,569 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,344 |
1,343 |
$17K |
| D1120 |
Prophylaxis - child |
417 |
416 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,613 |
2,563 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
228 |
151 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
898 |
897 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
74 |
50 |
$5K |