| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
816 |
800 |
$21K |
| D0274 |
Bitewings - four radiographic images |
1,112 |
1,085 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
350 |
232 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
844 |
824 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
414 |
223 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
2,050 |
1,997 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
1,038 |
1,006 |
$14K |
| D1120 |
Prophylaxis - child |
671 |
661 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,709 |
1,774 |
$13K |
| D1206 |
Topical application of fluoride varnish |
765 |
752 |
$9K |
| D0272 |
Bitewings - two radiographic images |
401 |
397 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
145 |
142 |
$2K |
| D1999 |
|
546 |
475 |
$0.00 |