| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,779 |
3,689 |
$126K |
| D0120 |
Periodic oral evaluation - established patient |
4,786 |
4,697 |
$104K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,783 |
4,038 |
$92K |
| D0274 |
Bitewings - four radiographic images |
3,135 |
3,081 |
$91K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
602 |
367 |
$46K |
| D0140 |
Limited oral evaluation - problem focused |
1,382 |
1,321 |
$37K |
| D1120 |
Prophylaxis - child |
594 |
594 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
333 |
333 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
73 |
41 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
699 |
667 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
75 |
39 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
31 |
31 |
$2K |
| D0272 |
Bitewings - two radiographic images |
51 |
50 |
$1K |