| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,986 |
3,484 |
$161K |
| D0120 |
Periodic oral evaluation - established patient |
3,700 |
3,245 |
$73K |
| D0274 |
Bitewings - four radiographic images |
2,188 |
1,899 |
$61K |
| D0330 |
Panoramic radiographic image |
1,248 |
1,068 |
$56K |
| D0140 |
Limited oral evaluation - problem focused |
1,622 |
1,361 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,126 |
977 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
1,712 |
1,427 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
841 |
730 |
$12K |
| D1206 |
Topical application of fluoride varnish |
497 |
445 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
513 |
346 |
$9K |
| D1120 |
Prophylaxis - child |
332 |
285 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
965 |
468 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
22 |
15 |
$2K |
| D0272 |
Bitewings - two radiographic images |
88 |
71 |
$2K |
| D1999 |
|
102 |
79 |
$60.00 |