| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,173 |
2,045 |
$106K |
| D0274 |
Bitewings - four radiographic images |
1,440 |
1,359 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
1,986 |
1,878 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
1,787 |
1,649 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,702 |
1,563 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
186 |
172 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
207 |
58 |
$11K |
| D0330 |
Panoramic radiographic image |
188 |
183 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
120 |
115 |
$5K |
| D0272 |
Bitewings - two radiographic images |
187 |
182 |
$4K |
| D1120 |
Prophylaxis - child |
101 |
89 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
125 |
113 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
18 |
12 |
$1K |