| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,892 |
1,885 |
$137K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,757 |
1,751 |
$107K |
| D0120 |
Periodic oral evaluation - established patient |
1,308 |
1,305 |
$62K |
| D0210 |
Intraoral - complete series of radiographic images |
1,581 |
1,577 |
$49K |
| D9430 |
|
1,625 |
1,522 |
$38K |
| D1206 |
Topical application of fluoride varnish |
1,660 |
1,658 |
$31K |
| D9999 |
Unspecified adjunctive procedure, by report |
249 |
248 |
$31K |
| D4341 |
|
140 |
45 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,099 |
1,073 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
259 |
254 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
712 |
394 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
35 |
16 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
33 |
13 |
$2K |
| D1120 |
Prophylaxis - child |
29 |
29 |
$1K |
| D0272 |
Bitewings - two radiographic images |
92 |
92 |
$526.00 |
| D0270 |
|
135 |
131 |
$315.50 |