| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,350 |
1,167 |
$43K |
| D0120 |
Periodic oral evaluation - established patient |
2,237 |
1,921 |
$33K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
594 |
302 |
$29K |
| D1120 |
Prophylaxis - child |
1,477 |
1,272 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,559 |
1,353 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
353 |
198 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
599 |
484 |
$15K |
| D0274 |
Bitewings - four radiographic images |
533 |
465 |
$13K |
| D0272 |
Bitewings - two radiographic images |
466 |
397 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
36 |
28 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
61 |
55 |
$2K |
| D0240 |
|
37 |
13 |
$386.28 |
| D0220 |
Intraoral - periapical first radiographic image |
44 |
38 |
$337.51 |