| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,242 |
2,233 |
$116K |
| D0120 |
Periodic oral evaluation - established patient |
2,228 |
2,225 |
$66K |
| D1206 |
Topical application of fluoride varnish |
2,082 |
2,077 |
$56K |
| D0274 |
Bitewings - four radiographic images |
1,485 |
1,482 |
$55K |
| D0220 |
Intraoral - periapical first radiographic image |
2,226 |
2,199 |
$39K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,955 |
1,867 |
$26K |
| D1120 |
Prophylaxis - child |
581 |
580 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
538 |
529 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
484 |
481 |
$20K |
| D1330 |
|
334 |
334 |
$12K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
49 |
27 |
$4K |
| D0272 |
Bitewings - two radiographic images |
73 |
73 |
$3K |
| D0330 |
Panoramic radiographic image |
80 |
80 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
63 |
37 |
$1K |