| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,901 |
2,848 |
$107K |
| D0120 |
Periodic oral evaluation - established patient |
3,616 |
3,549 |
$64K |
| D1206 |
Topical application of fluoride varnish |
3,674 |
3,603 |
$55K |
| D0274 |
Bitewings - four radiographic images |
1,995 |
1,948 |
$44K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
226 |
154 |
$16K |
| D1120 |
Prophylaxis - child |
434 |
427 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
989 |
946 |
$9K |
| D0330 |
Panoramic radiographic image |
173 |
165 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
46 |
26 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
338 |
280 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
41 |
38 |
$895.93 |
| D0140 |
Limited oral evaluation - problem focused |
24 |
24 |
$557.08 |
| D0603 |
|
105 |
101 |
$450.00 |