| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,871 |
2,844 |
$136K |
| D0120 |
Periodic oral evaluation - established patient |
2,715 |
2,696 |
$66K |
| D0274 |
Bitewings - four radiographic images |
1,766 |
1,755 |
$53K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
610 |
606 |
$25K |
| D1206 |
Topical application of fluoride varnish |
1,096 |
1,084 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,047 |
1,026 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
429 |
425 |
$10K |
| D1120 |
Prophylaxis - child |
203 |
203 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
76 |
75 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17 |
13 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
12 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
85 |
84 |
$2K |