| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,393 |
1,360 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
1,489 |
1,468 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
513 |
475 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,209 |
1,173 |
$15K |
| D1120 |
Prophylaxis - child |
623 |
595 |
$13K |
| D0274 |
Bitewings - four radiographic images |
714 |
683 |
$10K |
| D1206 |
Topical application of fluoride varnish |
678 |
656 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,002 |
942 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
153 |
53 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,353 |
843 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
90 |
86 |
$2K |
| D0272 |
Bitewings - two radiographic images |
107 |
104 |
$1K |
| D1999 |
|
57 |
55 |
$840.00 |