| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,326 |
1,259 |
$63K |
| D0274 |
Bitewings - four radiographic images |
1,398 |
1,319 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
1,215 |
1,161 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,930 |
1,830 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
2,377 |
2,232 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,250 |
2,013 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
196 |
86 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
577 |
536 |
$17K |
| D0145 |
Oral evaluation for a patient under three years of age |
132 |
122 |
$15K |
| D1120 |
Prophylaxis - child |
382 |
365 |
$12K |
| D0330 |
Panoramic radiographic image |
539 |
506 |
$9K |
| D0272 |
Bitewings - two radiographic images |
189 |
176 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
102 |
100 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
21 |
13 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$847.68 |
| D0603 |
|
1,085 |
1,031 |
$0.00 |
| D0602 |
|
669 |
636 |
$0.00 |
| D0601 |
|
322 |
298 |
$0.00 |