| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
10,480 |
9,939 |
$320K |
| D1208 |
Topical application of fluoride, excluding varnish |
16,212 |
15,299 |
$228K |
| D0120 |
Periodic oral evaluation - established patient |
12,028 |
11,420 |
$203K |
| D0240 |
|
14,088 |
6,763 |
$179K |
| D0210 |
Intraoral - complete series of radiographic images |
3,606 |
3,373 |
$159K |
| D1120 |
Prophylaxis - child |
6,302 |
5,972 |
$149K |
| D0274 |
Bitewings - four radiographic images |
6,827 |
6,475 |
$129K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,964 |
4,646 |
$107K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
630 |
359 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
1,717 |
1,615 |
$34K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
738 |
381 |
$32K |
| D0272 |
Bitewings - two radiographic images |
1,766 |
1,670 |
$24K |
| D4355 |
|
228 |
216 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,345 |
1,250 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
250 |
161 |
$2K |