| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,163 |
3,859 |
$193K |
| D0120 |
Periodic oral evaluation - established patient |
4,376 |
4,068 |
$95K |
| D0274 |
Bitewings - four radiographic images |
2,122 |
1,979 |
$70K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,307 |
1,188 |
$44K |
| D2394 |
|
281 |
135 |
$39K |
| D0210 |
Intraoral - complete series of radiographic images |
859 |
772 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,153 |
1,979 |
$29K |
| D1120 |
Prophylaxis - child |
817 |
761 |
$21K |
| D0330 |
Panoramic radiographic image |
479 |
441 |
$20K |
| D1206 |
Topical application of fluoride varnish |
982 |
910 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
73 |
41 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
69 |
43 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
40 |
36 |
$1K |
| D0272 |
Bitewings - two radiographic images |
52 |
50 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
22 |
13 |
$1K |