| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,124 |
2,968 |
$130K |
| D0120 |
Periodic oral evaluation - established patient |
3,796 |
3,627 |
$88K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,238 |
4,048 |
$84K |
| D0274 |
Bitewings - four radiographic images |
1,309 |
1,259 |
$35K |
| D0210 |
Intraoral - complete series of radiographic images |
592 |
564 |
$33K |
| D1120 |
Prophylaxis - child |
910 |
884 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,948 |
1,881 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
2,222 |
2,108 |
$27K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
158 |
57 |
$11K |
| D0272 |
Bitewings - two radiographic images |
426 |
414 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
114 |
41 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
166 |
155 |
$5K |