| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,692 |
1,681 |
$49K |
| D0210 |
Intraoral - complete series of radiographic images |
628 |
625 |
$32K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
558 |
374 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
1,466 |
1,458 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
641 |
638 |
$7K |
| D0330 |
Panoramic radiographic image |
137 |
136 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
216 |
151 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,927 |
1,914 |
$2K |
| D0274 |
Bitewings - four radiographic images |
1,101 |
1,095 |
$2K |
| D1330 |
|
1,961 |
1,948 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
12 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
14 |
14 |
$129.38 |
| D0220 |
Intraoral - periapical first radiographic image |
26 |
26 |
$19.06 |