| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
973 |
956 |
$49K |
| D0210 |
Intraoral - complete series of radiographic images |
391 |
376 |
$25K |
| D0274 |
Bitewings - four radiographic images |
476 |
472 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
560 |
531 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
419 |
410 |
$12K |
| D1120 |
Prophylaxis - child |
231 |
228 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
528 |
509 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
133 |
129 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
53 |
38 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
84 |
81 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
160 |
147 |
$2K |
| D0330 |
Panoramic radiographic image |
34 |
34 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
24 |
13 |
$1K |