| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,477 |
3,284 |
$125K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,105 |
564 |
$111K |
| D0120 |
Periodic oral evaluation - established patient |
4,395 |
4,143 |
$108K |
| D0274 |
Bitewings - four radiographic images |
2,615 |
2,456 |
$75K |
| D0220 |
Intraoral - periapical first radiographic image |
5,088 |
4,690 |
$71K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,434 |
1,336 |
$58K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,238 |
3,835 |
$49K |
| D1206 |
Topical application of fluoride varnish |
2,366 |
2,214 |
$36K |
| D1120 |
Prophylaxis - child |
1,364 |
1,287 |
$34K |
| D0330 |
Panoramic radiographic image |
584 |
548 |
$29K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
107 |
67 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
314 |
293 |
$11K |
| D0272 |
Bitewings - two radiographic images |
441 |
418 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
65 |
40 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
269 |
256 |
$4K |