| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0274 |
Bitewings - four radiographic images |
3,017 |
2,880 |
$88K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,229 |
381 |
$77K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,848 |
3,106 |
$74K |
| D0120 |
Periodic oral evaluation - established patient |
3,109 |
2,974 |
$70K |
| D0140 |
Limited oral evaluation - problem focused |
2,540 |
2,100 |
$68K |
| D1110 |
Prophylaxis - adult |
1,643 |
1,566 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,338 |
2,255 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
3,175 |
2,987 |
$39K |
| D1120 |
Prophylaxis - child |
822 |
791 |
$34K |
| D2332 |
|
17 |
13 |
$2K |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$183.04 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$165.88 |