| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,701 |
1,680 |
$62K |
| D0120 |
Periodic oral evaluation - established patient |
1,993 |
1,951 |
$51K |
| D0140 |
Limited oral evaluation - problem focused |
730 |
711 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,225 |
1,195 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,216 |
1,148 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
338 |
323 |
$14K |
| D1120 |
Prophylaxis - child |
368 |
365 |
$10K |
| D0274 |
Bitewings - four radiographic images |
297 |
291 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
28 |
28 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
14 |
$1K |
| D0170 |
|
24 |
22 |
$652.10 |
| D0272 |
Bitewings - two radiographic images |
27 |
27 |
$513.77 |
| D0230 |
Intraoral - periapical each additional radiographic image |
42 |
24 |
$487.97 |