| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,174 |
1,142 |
$61K |
| D1120 |
Prophylaxis - child |
833 |
817 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
1,563 |
1,529 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,198 |
1,168 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,029 |
1,000 |
$32K |
| D0330 |
Panoramic radiographic image |
527 |
520 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
240 |
125 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
419 |
410 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,157 |
1,122 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
846 |
822 |
$9K |
| D9110 |
|
142 |
140 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
28 |
19 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
29 |
27 |
$1K |