| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,440 |
1,425 |
$51K |
| D0120 |
Periodic oral evaluation - established patient |
1,667 |
1,646 |
$41K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
565 |
415 |
$37K |
| D0272 |
Bitewings - two radiographic images |
1,801 |
1,778 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
380 |
283 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,975 |
1,944 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,920 |
1,886 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
729 |
722 |
$13K |
| D1120 |
Prophylaxis - child |
451 |
445 |
$12K |
| D1330 |
|
1,783 |
1,761 |
$12K |
| D1310 |
|
1,731 |
1,710 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
242 |
240 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
64 |
53 |
$4K |
| D1351 |
Sealant - per tooth |
103 |
19 |
$3K |
| D0601 |
|
378 |
372 |
$2K |
| D9110 |
|
12 |
12 |
$385.10 |