| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,942 |
2,934 |
$102K |
| D1110 |
Prophylaxis - adult |
1,844 |
1,836 |
$75K |
| D0274 |
Bitewings - four radiographic images |
2,605 |
2,591 |
$72K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,555 |
3,323 |
$53K |
| D0220 |
Intraoral - periapical first radiographic image |
3,952 |
3,913 |
$44K |
| D4346 |
|
247 |
246 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,447 |
1,441 |
$26K |
| D0330 |
Panoramic radiographic image |
705 |
702 |
$21K |
| D1206 |
Topical application of fluoride varnish |
805 |
803 |
$14K |
| D1120 |
Prophylaxis - child |
361 |
361 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
106 |
67 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
206 |
201 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
244 |
244 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
95 |
53 |
$5K |