| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,097 |
2,007 |
$100K |
| D0274 |
Bitewings - four radiographic images |
844 |
802 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
315 |
300 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
888 |
849 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
226 |
167 |
$17K |
| D1120 |
Prophylaxis - child |
310 |
293 |
$15K |
| D1206 |
Topical application of fluoride varnish |
560 |
535 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
180 |
175 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
328 |
313 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
34 |
28 |
$4K |
| D3120 |
|
60 |
29 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
25 |
24 |
$907.00 |