| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,775 |
1,578 |
$84K |
| D0120 |
Periodic oral evaluation - established patient |
1,795 |
1,600 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
511 |
277 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
491 |
413 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
931 |
812 |
$16K |
| D0274 |
Bitewings - four radiographic images |
466 |
419 |
$14K |
| D1120 |
Prophylaxis - child |
201 |
173 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
347 |
270 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
39 |
29 |
$3K |
| D1206 |
Topical application of fluoride varnish |
93 |
89 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
72 |
61 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
13 |
12 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
24 |
12 |
$218.00 |
| D0160 |
|
17 |
16 |
$161.00 |