| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,962 |
2,939 |
$161K |
| D0210 |
Intraoral - complete series of radiographic images |
1,174 |
1,159 |
$86K |
| D1120 |
Prophylaxis - child |
1,551 |
1,543 |
$80K |
| D0274 |
Bitewings - four radiographic images |
2,135 |
2,119 |
$79K |
| D0120 |
Periodic oral evaluation - established patient |
2,751 |
2,742 |
$71K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,466 |
1,448 |
$64K |
| D0180 |
|
1,417 |
1,401 |
$56K |
| D1206 |
Topical application of fluoride varnish |
2,110 |
2,095 |
$56K |
| D0140 |
Limited oral evaluation - problem focused |
1,060 |
1,011 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
1,544 |
1,465 |
$25K |
| D0330 |
Panoramic radiographic image |
223 |
219 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
868 |
594 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
84 |
41 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
54 |
39 |
$4K |
| D3120 |
|
96 |
57 |
$3K |
| D9110 |
|
14 |
13 |
$588.00 |