| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,023 |
997 |
$54K |
| D0274 |
Bitewings - four radiographic images |
1,451 |
1,406 |
$51K |
| D0140 |
Limited oral evaluation - problem focused |
919 |
765 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
1,092 |
1,061 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
1,228 |
1,095 |
$20K |
| D3120 |
|
606 |
264 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
112 |
64 |
$19K |
| D2394 |
|
102 |
55 |
$18K |
| D0330 |
Panoramic radiographic image |
278 |
268 |
$15K |
| D4341 |
|
83 |
28 |
$14K |
| D9110 |
|
204 |
145 |
$13K |
| D1206 |
Topical application of fluoride varnish |
564 |
546 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
609 |
600 |
$11K |
| D9310 |
|
161 |
152 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
202 |
196 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
54 |
28 |
$6K |
| D1320 |
|
24 |
24 |
$833.16 |
| D0230 |
Intraoral - periapical each additional radiographic image |
42 |
36 |
$411.70 |