| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
490 |
478 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
503 |
496 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
149 |
140 |
$6K |
| D0274 |
Bitewings - four radiographic images |
296 |
291 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
341 |
333 |
$5K |
| D1206 |
Topical application of fluoride varnish |
310 |
301 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
59 |
30 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
523 |
491 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
485 |
371 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
52 |
48 |
$903.20 |
| D1208 |
Topical application of fluoride, excluding varnish |
76 |
73 |
$900.00 |
| D1120 |
Prophylaxis - child |
51 |
48 |
$860.00 |