| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,168 |
2,030 |
$116K |
| D0120 |
Periodic oral evaluation - established patient |
2,663 |
2,519 |
$64K |
| D0274 |
Bitewings - four radiographic images |
1,539 |
1,429 |
$55K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,204 |
1,150 |
$33K |
| D1120 |
Prophylaxis - child |
605 |
571 |
$29K |
| D0330 |
Panoramic radiographic image |
120 |
115 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
46 |
27 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
67 |
65 |
$3K |
| D1206 |
Topical application of fluoride varnish |
109 |
106 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
173 |
155 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
46 |
40 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
35 |
16 |
$378.00 |