| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
3,532 |
3,105 |
$100K |
| D1110 |
Prophylaxis - adult |
1,713 |
1,650 |
$58K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
329 |
217 |
$27K |
| D2394 |
|
259 |
176 |
$26K |
| D0210 |
Intraoral - complete series of radiographic images |
482 |
467 |
$25K |
| D0274 |
Bitewings - four radiographic images |
793 |
777 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,019 |
990 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
391 |
377 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
479 |
432 |
$5K |
| D1120 |
Prophylaxis - child |
75 |
75 |
$3K |
| D0330 |
Panoramic radiographic image |
46 |
42 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
13 |
12 |
$248.50 |