| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,274 |
1,241 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
2,066 |
2,035 |
$55K |
| D4910 |
|
770 |
770 |
$53K |
| D0274 |
Bitewings - four radiographic images |
1,752 |
1,726 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,526 |
2,480 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
2,337 |
2,254 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
679 |
669 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,161 |
1,797 |
$19K |
| D4341 |
|
191 |
95 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
169 |
169 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
78 |
54 |
$6K |
| D0330 |
Panoramic radiographic image |
98 |
86 |
$4K |
| D1120 |
Prophylaxis - child |
72 |
72 |
$3K |
| D1999 |
|
593 |
375 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
24 |
13 |
$1K |