| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
845 |
818 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
790 |
778 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
794 |
749 |
$18K |
| D1120 |
Prophylaxis - child |
348 |
344 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
2,195 |
2,001 |
$13K |
| D0272 |
Bitewings - two radiographic images |
1,317 |
1,273 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
444 |
430 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,997 |
1,817 |
$9K |
| D2140 |
|
101 |
68 |
$5K |
| D2332 |
|
23 |
12 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
14 |
12 |
$582.40 |