| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
117 |
116 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
674 |
632 |
$7K |
| D9110 |
|
108 |
106 |
$7K |
| D7510 |
|
94 |
94 |
$6K |
| D4910 |
|
71 |
71 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
308 |
282 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
121 |
121 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
84 |
83 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
320 |
318 |
$3K |
| D9430 |
|
80 |
72 |
$2K |
| D4341 |
|
45 |
12 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
23 |
14 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
33 |
33 |
$1K |