| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,298 |
2,126 |
$56K |
| D1110 |
Prophylaxis - adult |
1,240 |
1,136 |
$48K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
677 |
389 |
$35K |
| D9420 |
|
529 |
462 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
456 |
229 |
$17K |
| D0274 |
Bitewings - four radiographic images |
594 |
547 |
$14K |
| D1120 |
Prophylaxis - child |
246 |
233 |
$10K |
| D1206 |
Topical application of fluoride varnish |
440 |
417 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
705 |
650 |
$5K |
| D9110 |
|
157 |
151 |
$4K |
| D0330 |
Panoramic radiographic image |
65 |
62 |
$3K |
| D0272 |
Bitewings - two radiographic images |
184 |
175 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
40 |
26 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
113 |
108 |
$2K |
| D9986 |
|
67 |
61 |
$45.00 |