| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,350 |
1,283 |
$66K |
| D0120 |
Periodic oral evaluation - established patient |
1,320 |
1,265 |
$29K |
| D0274 |
Bitewings - four radiographic images |
814 |
771 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
357 |
181 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
976 |
928 |
$14K |
| D1206 |
Topical application of fluoride varnish |
361 |
348 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
723 |
672 |
$9K |
| D1120 |
Prophylaxis - child |
166 |
163 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
60 |
41 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
97 |
95 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
117 |
113 |
$4K |
| D2140 |
|
21 |
13 |
$1K |