| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,724 |
3,688 |
$146K |
| D0120 |
Periodic oral evaluation - established patient |
3,971 |
3,948 |
$95K |
| D1120 |
Prophylaxis - child |
1,830 |
1,819 |
$75K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,592 |
2,581 |
$58K |
| D1206 |
Topical application of fluoride varnish |
1,125 |
1,099 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
676 |
666 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,244 |
1,238 |
$28K |
| D0274 |
Bitewings - four radiographic images |
2,375 |
2,349 |
$22K |
| D0330 |
Panoramic radiographic image |
960 |
944 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
315 |
315 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
2,676 |
2,625 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,229 |
2,040 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
199 |
142 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
118 |
87 |
$8K |
| D0601 |
|
696 |
678 |
$6K |
| D0272 |
Bitewings - two radiographic images |
28 |
28 |
$170.00 |
| D0602 |
|
13 |
13 |
$130.00 |
| D1999 |
|
19 |
18 |
$0.00 |