| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,906 |
2,772 |
$71K |
| D1110 |
Prophylaxis - adult |
1,624 |
1,545 |
$69K |
| D5110 |
|
120 |
112 |
$68K |
| D5120 |
|
89 |
83 |
$49K |
| D1120 |
Prophylaxis - child |
988 |
958 |
$47K |
| D0274 |
Bitewings - four radiographic images |
1,687 |
1,610 |
$45K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
643 |
363 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,826 |
1,745 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,788 |
1,796 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
553 |
250 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
2,226 |
2,099 |
$20K |
| D0330 |
Panoramic radiographic image |
345 |
332 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
128 |
123 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
90 |
88 |
$3K |