| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,598 |
6,184 |
$215K |
| D0120 |
Periodic oral evaluation - established patient |
9,439 |
8,500 |
$146K |
| D1206 |
Topical application of fluoride varnish |
4,874 |
4,164 |
$63K |
| D0274 |
Bitewings - four radiographic images |
1,779 |
1,665 |
$38K |
| D1120 |
Prophylaxis - child |
1,546 |
1,207 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
883 |
689 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
766 |
652 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
77 |
53 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
221 |
184 |
$4K |
| D0330 |
Panoramic radiographic image |
152 |
129 |
$4K |
| D0272 |
Bitewings - two radiographic images |
252 |
238 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
140 |
115 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
12 |
$626.28 |
| D0460 |
|
14 |
12 |
$30.00 |