| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,452 |
1,444 |
$68K |
| D0120 |
Periodic oral evaluation - established patient |
1,044 |
1,038 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
416 |
413 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
961 |
948 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
276 |
274 |
$6K |
| D0274 |
Bitewings - four radiographic images |
159 |
159 |
$4K |
| D1320 |
|
431 |
426 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
471 |
469 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
29 |
27 |
$2K |
| D9110 |
|
130 |
127 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
40 |
40 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
132 |
129 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
13 |
12 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
82 |
82 |
$712.46 |