| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,391 |
1,346 |
$45K |
| D0120 |
Periodic oral evaluation - established patient |
1,852 |
1,785 |
$30K |
| D0274 |
Bitewings - four radiographic images |
934 |
901 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
267 |
140 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
963 |
939 |
$10K |
| D1120 |
Prophylaxis - child |
357 |
348 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
830 |
761 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
198 |
174 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
100 |
99 |
$3K |
| D0330 |
Panoramic radiographic image |
48 |
47 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
383 |
337 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
14 |
$1K |
| D2394 |
|
14 |
12 |
$1K |