| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
782 |
731 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
1,112 |
1,042 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
661 |
525 |
$23K |
| D7962 |
|
145 |
141 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
356 |
333 |
$15K |
| D1120 |
Prophylaxis - child |
563 |
538 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
916 |
819 |
$13K |
| D0274 |
Bitewings - four radiographic images |
357 |
331 |
$10K |
| D1206 |
Topical application of fluoride varnish |
663 |
620 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
905 |
681 |
$10K |
| D7961 |
|
93 |
83 |
$9K |
| D0330 |
Panoramic radiographic image |
101 |
94 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
42 |
28 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
58 |
37 |
$4K |
| D0272 |
Bitewings - two radiographic images |
162 |
154 |
$3K |
| D1354 |
|
40 |
12 |
$236.50 |
| D0145 |
Oral evaluation for a patient under three years of age |
25 |
25 |
$0.00 |