| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
886 |
860 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
645 |
625 |
$14K |
| D0274 |
Bitewings - four radiographic images |
368 |
359 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
124 |
119 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
81 |
56 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
138 |
135 |
$6K |
| D4341 |
|
56 |
14 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
278 |
265 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
98 |
98 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
69 |
66 |
$3K |
| D1120 |
Prophylaxis - child |
42 |
42 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
14 |
12 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
84 |
56 |
$998.00 |