| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,258 |
4,181 |
$218K |
| D0120 |
Periodic oral evaluation - established patient |
4,478 |
4,395 |
$113K |
| D0274 |
Bitewings - four radiographic images |
1,444 |
1,418 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
862 |
847 |
$30K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
230 |
160 |
$30K |
| D1206 |
Topical application of fluoride varnish |
1,017 |
999 |
$23K |
| D1120 |
Prophylaxis - child |
507 |
502 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
524 |
513 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
951 |
924 |
$16K |
| D0330 |
Panoramic radiographic image |
266 |
259 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
270 |
249 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
29 |
29 |
$2K |
| D2950 |
|
13 |
12 |
$1K |
| D1999 |
|
1,391 |
1,303 |
$569.50 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$331.09 |