| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,276 |
1,244 |
$47K |
| D0140 |
Limited oral evaluation - problem focused |
1,189 |
1,106 |
$35K |
| D0330 |
Panoramic radiographic image |
648 |
621 |
$34K |
| D0274 |
Bitewings - four radiographic images |
948 |
926 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
705 |
667 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
2,146 |
1,969 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,089 |
1,041 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
157 |
83 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
624 |
613 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,289 |
1,204 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
175 |
164 |
$9K |
| D1206 |
Topical application of fluoride varnish |
336 |
325 |
$6K |
| D2394 |
|
34 |
24 |
$5K |
| D1120 |
Prophylaxis - child |
46 |
45 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20 |
14 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
15 |
14 |
$1K |