| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,778 |
3,745 |
$155K |
| D0120 |
Periodic oral evaluation - established patient |
5,529 |
5,475 |
$96K |
| D1206 |
Topical application of fluoride varnish |
3,878 |
3,842 |
$72K |
| D1120 |
Prophylaxis - child |
2,170 |
2,149 |
$66K |
| D0272 |
Bitewings - two radiographic images |
833 |
831 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
667 |
666 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
349 |
349 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
182 |
147 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
59 |
59 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
356 |
353 |
$4K |
| D0330 |
Panoramic radiographic image |
58 |
58 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20 |
12 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
54 |
53 |
$918.72 |