| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,864 |
1,779 |
$82K |
| D0120 |
Periodic oral evaluation - established patient |
1,759 |
1,686 |
$43K |
| D1120 |
Prophylaxis - child |
651 |
632 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
614 |
581 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
861 |
831 |
$22K |
| D1206 |
Topical application of fluoride varnish |
724 |
707 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
344 |
326 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
209 |
120 |
$12K |
| D2752 |
|
16 |
13 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,451 |
1,350 |
$8K |
| D0274 |
Bitewings - four radiographic images |
587 |
557 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
717 |
668 |
$3K |
| D0272 |
Bitewings - two radiographic images |
24 |
24 |
$340.00 |
| D0270 |
|
50 |
48 |
$245.00 |