| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,788 |
1,773 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
1,254 |
1,243 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
487 |
482 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
344 |
339 |
$9K |
| D0274 |
Bitewings - four radiographic images |
1,019 |
1,011 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
1,952 |
1,877 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,666 |
1,576 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
400 |
396 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
76 |
49 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
125 |
120 |
$2K |
| D0191 |
|
247 |
233 |
$2K |
| D1120 |
Prophylaxis - child |
62 |
62 |
$868.00 |
| D0180 |
|
61 |
61 |
$854.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
15 |
13 |
$570.00 |
| D0601 |
|
122 |
120 |
$290.00 |
| D9310 |
|
13 |
12 |
$119.00 |
| D0272 |
Bitewings - two radiographic images |
16 |
16 |
$80.00 |
| D0602 |
|
14 |
14 |
$30.00 |