| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,021 |
1,941 |
$102K |
| D0274 |
Bitewings - four radiographic images |
1,423 |
1,394 |
$49K |
| D0120 |
Periodic oral evaluation - established patient |
1,505 |
1,479 |
$40K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
255 |
137 |
$33K |
| D1120 |
Prophylaxis - child |
653 |
628 |
$26K |
| D0330 |
Panoramic radiographic image |
245 |
241 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
314 |
309 |
$11K |
| D1206 |
Topical application of fluoride varnish |
341 |
330 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
390 |
388 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
402 |
390 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
145 |
140 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
397 |
136 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
38 |
25 |
$2K |
| D1354 |
|
70 |
25 |
$1K |
| D0272 |
Bitewings - two radiographic images |
53 |
53 |
$1K |