| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
791 |
779 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
961 |
950 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
706 |
696 |
$10K |
| D0274 |
Bitewings - four radiographic images |
520 |
509 |
$9K |
| D1120 |
Prophylaxis - child |
419 |
416 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,252 |
1,207 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,114 |
979 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
105 |
105 |
$3K |
| D0350 |
|
230 |
227 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
56 |
28 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20 |
13 |
$1K |
| D0272 |
Bitewings - two radiographic images |
98 |
97 |
$910.00 |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$509.52 |
| D0210 |
Intraoral - complete series of radiographic images |
21 |
13 |
$346.04 |