| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,403 |
1,401 |
$65K |
| D0120 |
Periodic oral evaluation - established patient |
1,839 |
1,834 |
$51K |
| D0220 |
Intraoral - periapical first radiographic image |
1,672 |
1,605 |
$22K |
| D0274 |
Bitewings - four radiographic images |
612 |
610 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,227 |
1,025 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
571 |
567 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
243 |
230 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
114 |
57 |
$6K |
| D1206 |
Topical application of fluoride varnish |
249 |
247 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
54 |
24 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
61 |
60 |
$3K |
| D1999 |
|
765 |
606 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
87 |
87 |
$3K |
| D1120 |
Prophylaxis - child |
59 |
58 |
$2K |
| D0602 |
|
214 |
214 |
$2K |
| D0603 |
|
144 |
144 |
$2K |
| D0601 |
|
14 |
14 |
$154.00 |
| D1330 |
|
26 |
26 |
$0.00 |