| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,154 |
1,123 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
1,429 |
1,405 |
$39K |
| D1206 |
Topical application of fluoride varnish |
1,489 |
1,465 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
555 |
534 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
616 |
570 |
$25K |
| D0274 |
Bitewings - four radiographic images |
1,041 |
1,015 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
2,304 |
1,948 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,852 |
1,510 |
$22K |
| D1120 |
Prophylaxis - child |
463 |
459 |
$21K |
| D2750 |
|
44 |
26 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
132 |
68 |
$16K |
| D3110 |
|
753 |
210 |
$11K |
| D0330 |
Panoramic radiographic image |
59 |
57 |
$3K |
| D1330 |
|
659 |
645 |
$3K |
| D2954 |
|
27 |
15 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
40 |
39 |
$778.00 |