| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,262 |
2,193 |
$97K |
| D0120 |
Periodic oral evaluation - established patient |
2,662 |
2,571 |
$76K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,417 |
2,335 |
$63K |
| D0274 |
Bitewings - four radiographic images |
835 |
808 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
1,714 |
1,621 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,750 |
1,219 |
$24K |
| D1110 |
Prophylaxis - adult |
739 |
710 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
346 |
320 |
$10K |
| D2394 |
|
82 |
50 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
139 |
137 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
50 |
27 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
48 |
31 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
74 |
74 |
$4K |
| D2161 |
|
19 |
14 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
22 |
13 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
15 |
12 |
$1K |