| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,944 |
1,938 |
$85K |
| D0120 |
Periodic oral evaluation - established patient |
1,999 |
1,996 |
$50K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
254 |
147 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
364 |
357 |
$16K |
| D1120 |
Prophylaxis - child |
281 |
281 |
$13K |
| D0330 |
Panoramic radiographic image |
291 |
291 |
$12K |
| D0274 |
Bitewings - four radiographic images |
871 |
870 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
305 |
304 |
$8K |
| D2750 |
|
13 |
12 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
1,391 |
1,362 |
$7K |
| D0272 |
Bitewings - two radiographic images |
511 |
511 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
791 |
784 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
110 |
110 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
47 |
38 |
$3K |