| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,373 |
1,326 |
$31K |
| D1110 |
Prophylaxis - adult |
762 |
738 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
508 |
357 |
$26K |
| D1120 |
Prophylaxis - child |
352 |
347 |
$15K |
| D1206 |
Topical application of fluoride varnish |
601 |
587 |
$8K |
| D0274 |
Bitewings - four radiographic images |
309 |
302 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
53 |
39 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
59 |
41 |
$2K |
| D0272 |
Bitewings - two radiographic images |
121 |
118 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
222 |
217 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
26 |
24 |
$1K |