| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,286 |
1,169 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,249 |
2,086 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
1,744 |
1,600 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
381 |
258 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
468 |
317 |
$22K |
| D1120 |
Prophylaxis - child |
871 |
812 |
$20K |
| D0274 |
Bitewings - four radiographic images |
949 |
881 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
630 |
575 |
$13K |
| D0330 |
Panoramic radiographic image |
347 |
301 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
103 |
76 |
$7K |
| D0272 |
Bitewings - two radiographic images |
236 |
224 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
167 |
160 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
391 |
364 |
$3K |
| D4910 |
|
31 |
29 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
12 |
$664.19 |
| D0230 |
Intraoral - periapical each additional radiographic image |
127 |
87 |
$662.58 |