| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,906 |
1,778 |
$68K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
870 |
227 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,198 |
1,608 |
$36K |
| D0274 |
Bitewings - four radiographic images |
1,629 |
1,531 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
1,674 |
1,565 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
913 |
864 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,870 |
1,734 |
$10K |
| D2330 |
|
175 |
65 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
324 |
312 |
$8K |
| D2394 |
|
68 |
48 |
$5K |
| D1120 |
Prophylaxis - child |
180 |
162 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
42 |
37 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
25 |
14 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
46 |
39 |
$1K |
| D0272 |
Bitewings - two radiographic images |
70 |
68 |
$808.30 |