| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,406 |
4,392 |
$381K |
| D0120 |
Periodic oral evaluation - established patient |
4,532 |
4,514 |
$279K |
| D0230 |
Intraoral - periapical each additional radiographic image |
31,824 |
4,605 |
$127K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,353 |
5,334 |
$74K |
| D0220 |
Intraoral - periapical first radiographic image |
4,179 |
4,104 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
698 |
698 |
$43K |
| D0274 |
Bitewings - four radiographic images |
1,516 |
1,516 |
$32K |
| D1120 |
Prophylaxis - child |
622 |
622 |
$24K |
| D9430 |
|
738 |
731 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
350 |
346 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
241 |
199 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
151 |
129 |
$12K |
| D4910 |
|
24 |
24 |
$2K |