| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,577 |
2,552 |
$106K |
| D1120 |
Prophylaxis - child |
3,489 |
3,462 |
$103K |
| D0120 |
Periodic oral evaluation - established patient |
4,945 |
4,902 |
$85K |
| D0272 |
Bitewings - two radiographic images |
1,611 |
1,595 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,559 |
1,545 |
$30K |
| D0330 |
Panoramic radiographic image |
476 |
476 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
638 |
630 |
$20K |
| D0274 |
Bitewings - four radiographic images |
618 |
608 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
136 |
92 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
122 |
98 |
$10K |
| D1206 |
Topical application of fluoride varnish |
494 |
490 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
155 |
150 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
149 |
149 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$297.96 |