| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,664 |
3,598 |
$61K |
| D0120 |
Periodic oral evaluation - established patient |
3,299 |
3,255 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,272 |
3,219 |
$23K |
| D1120 |
Prophylaxis - child |
1,170 |
1,156 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,208 |
2,169 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
729 |
409 |
$20K |
| D0274 |
Bitewings - four radiographic images |
2,061 |
2,033 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
728 |
703 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
2,799 |
2,756 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
190 |
113 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,787 |
2,469 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
13 |
$410.00 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$101.00 |