| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,572 |
3,565 |
$126K |
| D0210 |
Intraoral - complete series of radiographic images |
1,513 |
1,509 |
$52K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
909 |
574 |
$47K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
647 |
302 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
2,177 |
2,175 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,769 |
1,766 |
$34K |
| D0274 |
Bitewings - four radiographic images |
2,010 |
2,008 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
3,467 |
3,353 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
1,565 |
1,535 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,749 |
2,710 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
817 |
817 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
181 |
103 |
$6K |
| D2335 |
|
51 |
38 |
$5K |
| D2394 |
|
17 |
13 |
$2K |
| D0270 |
|
42 |
42 |
$342.40 |