| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,014 |
1,872 |
$64K |
| D0120 |
Periodic oral evaluation - established patient |
2,469 |
2,264 |
$52K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
420 |
217 |
$39K |
| D0274 |
Bitewings - four radiographic images |
1,297 |
1,177 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
2,315 |
2,039 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,188 |
1,659 |
$22K |
| D0330 |
Panoramic radiographic image |
358 |
331 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,145 |
1,069 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
388 |
342 |
$12K |
| D1120 |
Prophylaxis - child |
425 |
409 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
185 |
176 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
53 |
39 |
$4K |
| D0272 |
Bitewings - two radiographic images |
24 |
24 |
$448.93 |
| D1206 |
Topical application of fluoride varnish |
22 |
12 |
$0.00 |