| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,481 |
4,478 |
$157K |
| D0274 |
Bitewings - four radiographic images |
4,244 |
4,244 |
$79K |
| D0120 |
Periodic oral evaluation - established patient |
3,756 |
3,753 |
$74K |
| D0220 |
Intraoral - periapical first radiographic image |
4,121 |
4,100 |
$39K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,031 |
4,026 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,406 |
1,406 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,931 |
2,929 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
1,407 |
1,407 |
$25K |
| D1120 |
Prophylaxis - child |
597 |
597 |
$18K |
| D2750 |
|
29 |
25 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
161 |
127 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
119 |
90 |
$6K |
| D1320 |
|
433 |
432 |
$3K |
| D0330 |
Panoramic radiographic image |
93 |
93 |
$2K |
| D9110 |
|
36 |
36 |
$452.30 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$117.42 |