| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,124 |
2,007 |
$103K |
| D0274 |
Bitewings - four radiographic images |
1,498 |
1,424 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
932 |
880 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
1,372 |
1,296 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
1,611 |
1,514 |
$22K |
| D0330 |
Panoramic radiographic image |
544 |
518 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,463 |
1,374 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
206 |
198 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
71 |
44 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
139 |
133 |
$4K |
| D1120 |
Prophylaxis - child |
58 |
54 |
$3K |