| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,395 |
1,344 |
$51K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
481 |
290 |
$49K |
| D0120 |
Periodic oral evaluation - established patient |
1,679 |
1,604 |
$41K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
451 |
278 |
$35K |
| D0274 |
Bitewings - four radiographic images |
893 |
872 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,159 |
1,123 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,099 |
1,038 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
447 |
412 |
$15K |
| D0330 |
Panoramic radiographic image |
266 |
263 |
$13K |
| D1120 |
Prophylaxis - child |
456 |
428 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
228 |
225 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
761 |
662 |
$9K |
| D2335 |
|
21 |
12 |
$2K |
| D4355 |
|
29 |
29 |
$2K |
| D0272 |
Bitewings - two radiographic images |
55 |
55 |
$1K |
| D1999 |
|
31 |
29 |
$0.00 |