| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,533 |
2,290 |
$107K |
| D0120 |
Periodic oral evaluation - established patient |
3,210 |
2,956 |
$65K |
| D0274 |
Bitewings - four radiographic images |
1,411 |
1,263 |
$45K |
| D1120 |
Prophylaxis - child |
1,271 |
1,180 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,726 |
1,575 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
596 |
521 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
234 |
142 |
$14K |
| D0330 |
Panoramic radiographic image |
194 |
183 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
805 |
703 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
143 |
87 |
$8K |
| D0272 |
Bitewings - two radiographic images |
371 |
339 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
778 |
321 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
138 |
122 |
$5K |
| D1999 |
|
160 |
139 |
$40.00 |