| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1208 |
Topical application of fluoride, excluding varnish |
336 |
325 |
$7K |
| D1110 |
Prophylaxis - adult |
178 |
174 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
205 |
198 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
85 |
84 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
96 |
94 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
326 |
299 |
$4K |
| D0274 |
Bitewings - four radiographic images |
97 |
91 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
75 |
72 |
$2K |
| D1120 |
Prophylaxis - child |
45 |
44 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
127 |
104 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
20 |
13 |
$1K |