| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,922 |
2,904 |
$128K |
| D0120 |
Periodic oral evaluation - established patient |
3,030 |
3,009 |
$74K |
| D0274 |
Bitewings - four radiographic images |
2,496 |
2,483 |
$71K |
| D1206 |
Topical application of fluoride varnish |
2,705 |
2,687 |
$61K |
| D0140 |
Limited oral evaluation - problem focused |
1,570 |
1,527 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
2,498 |
2,423 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,750 |
1,378 |
$28K |
| D0330 |
Panoramic radiographic image |
428 |
427 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
162 |
99 |
$10K |
| D1120 |
Prophylaxis - child |
297 |
294 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
354 |
353 |
$8K |
| D2161 |
|
62 |
50 |
$6K |
| D0272 |
Bitewings - two radiographic images |
174 |
171 |
$5K |
| D2335 |
|
23 |
12 |
$2K |
| D2394 |
|
19 |
14 |
$2K |
| D9985 |
|
12 |
12 |
$0.00 |