| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,184 |
1,182 |
$65K |
| D0140 |
Limited oral evaluation - problem focused |
1,083 |
1,029 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
1,174 |
1,173 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
820 |
818 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,176 |
1,062 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
112 |
54 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
74 |
49 |
$6K |
| D0274 |
Bitewings - four radiographic images |
347 |
347 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
82 |
82 |
$6K |
| D1120 |
Prophylaxis - child |
56 |
56 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
82 |
82 |
$3K |
| D9110 |
|
83 |
80 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
27 |
24 |
$150.50 |