| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,849 |
1,723 |
$66K |
| D0210 |
Intraoral - complete series of radiographic images |
965 |
867 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,181 |
1,089 |
$49K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
478 |
251 |
$45K |
| D0330 |
Panoramic radiographic image |
888 |
742 |
$34K |
| D0140 |
Limited oral evaluation - problem focused |
892 |
737 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
1,050 |
986 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
309 |
163 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,180 |
985 |
$14K |
| D1206 |
Topical application of fluoride varnish |
476 |
457 |
$8K |
| D0274 |
Bitewings - four radiographic images |
184 |
173 |
$5K |
| D4346 |
|
141 |
106 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
120 |
97 |
$1K |
| D1120 |
Prophylaxis - child |
13 |
13 |
$336.31 |