| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,616 |
1,551 |
$70K |
| D0120 |
Periodic oral evaluation - established patient |
2,414 |
2,314 |
$58K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,943 |
1,863 |
$36K |
| D0272 |
Bitewings - two radiographic images |
1,820 |
1,742 |
$36K |
| D0210 |
Intraoral - complete series of radiographic images |
349 |
346 |
$27K |
| D1120 |
Prophylaxis - child |
718 |
689 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
663 |
622 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
69 |
41 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
306 |
238 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
102 |
95 |
$3K |
| D2140 |
|
41 |
28 |
$2K |
| D0330 |
Panoramic radiographic image |
139 |
126 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16 |
12 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
15 |
14 |
$1K |