| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,372 |
1,330 |
$61K |
| D0120 |
Periodic oral evaluation - established patient |
1,300 |
1,264 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,250 |
1,223 |
$24K |
| D0272 |
Bitewings - two radiographic images |
1,206 |
1,173 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
298 |
278 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,276 |
1,187 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
506 |
461 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
759 |
710 |
$10K |
| D0330 |
Panoramic radiographic image |
155 |
147 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
115 |
115 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
13 |
$1K |
| D0601 |
|
304 |
287 |
$1K |
| D0603 |
|
175 |
163 |
$495.00 |
| D1206 |
Topical application of fluoride varnish |
20 |
20 |
$339.15 |
| D0602 |
|
18 |
17 |
$60.00 |