| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,130 |
2,880 |
$147K |
| D0120 |
Periodic oral evaluation - established patient |
3,998 |
3,811 |
$110K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,976 |
2,968 |
$62K |
| D1120 |
Prophylaxis - child |
1,618 |
1,607 |
$57K |
| D0272 |
Bitewings - two radiographic images |
2,439 |
2,414 |
$53K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
889 |
575 |
$51K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
330 |
223 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
592 |
519 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
909 |
793 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
65 |
47 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
30 |
26 |
$374.27 |
| D0140 |
Limited oral evaluation - problem focused |
15 |
14 |
$180.10 |