| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,573 |
4,432 |
$156K |
| D0120 |
Periodic oral evaluation - established patient |
4,930 |
4,752 |
$108K |
| D0274 |
Bitewings - four radiographic images |
2,895 |
2,822 |
$85K |
| D0210 |
Intraoral - complete series of radiographic images |
1,231 |
1,184 |
$67K |
| D0140 |
Limited oral evaluation - problem focused |
2,274 |
2,116 |
$59K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,106 |
3,053 |
$58K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
779 |
461 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,058 |
809 |
$33K |
| D1120 |
Prophylaxis - child |
766 |
760 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
856 |
804 |
$9K |
| D2394 |
|
42 |
24 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
45 |
24 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
264 |
130 |
$3K |