| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,385 |
2,372 |
$61K |
| D0120 |
Periodic oral evaluation - established patient |
3,322 |
3,301 |
$51K |
| D1120 |
Prophylaxis - child |
1,486 |
1,474 |
$33K |
| D1206 |
Topical application of fluoride varnish |
1,507 |
1,495 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
605 |
357 |
$21K |
| D0274 |
Bitewings - four radiographic images |
1,864 |
1,855 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
2,737 |
2,684 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,362 |
2,199 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
508 |
507 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
254 |
248 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
137 |
74 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
135 |
135 |
$4K |
| D0330 |
Panoramic radiographic image |
35 |
35 |
$0.00 |