| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
291 |
281 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
417 |
403 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
449 |
433 |
$8K |
| D1120 |
Prophylaxis - child |
164 |
158 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
85 |
34 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
68 |
37 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
63 |
61 |
$3K |
| D0272 |
Bitewings - two radiographic images |
193 |
187 |
$3K |
| D0274 |
Bitewings - four radiographic images |
131 |
126 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
53 |
52 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
88 |
76 |
$895.28 |
| D0330 |
Panoramic radiographic image |
18 |
17 |
$646.49 |
| D0140 |
Limited oral evaluation - problem focused |
31 |
27 |
$561.20 |