| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,978 |
1,827 |
$91K |
| D0120 |
Periodic oral evaluation - established patient |
2,381 |
2,214 |
$50K |
| D0274 |
Bitewings - four radiographic images |
1,227 |
1,123 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,194 |
1,113 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
290 |
271 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
117 |
65 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
59 |
36 |
$5K |
| D1120 |
Prophylaxis - child |
169 |
151 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
73 |
68 |
$4K |
| D0330 |
Panoramic radiographic image |
49 |
49 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
43 |
42 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
12 |
$129.88 |