| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
986 |
967 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
1,237 |
1,222 |
$22K |
| D0274 |
Bitewings - four radiographic images |
766 |
752 |
$18K |
| D1120 |
Prophylaxis - child |
461 |
455 |
$15K |
| D1206 |
Topical application of fluoride varnish |
515 |
506 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
444 |
438 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
35 |
27 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
61 |
60 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
15 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
157 |
152 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
51 |
48 |
$986.22 |
| D0210 |
Intraoral - complete series of radiographic images |
34 |
25 |
$913.23 |
| D0330 |
Panoramic radiographic image |
14 |
13 |
$772.09 |
| D0272 |
Bitewings - two radiographic images |
17 |
17 |
$342.55 |