| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,213 |
1,199 |
$47K |
| D0140 |
Limited oral evaluation - problem focused |
1,117 |
1,104 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,728 |
1,712 |
$36K |
| D0274 |
Bitewings - four radiographic images |
914 |
904 |
$31K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
347 |
257 |
$30K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
249 |
180 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
349 |
223 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
517 |
507 |
$24K |
| D0330 |
Panoramic radiographic image |
377 |
363 |
$23K |
| D1120 |
Prophylaxis - child |
474 |
466 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,430 |
506 |
$16K |
| D2394 |
|
96 |
72 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
663 |
641 |
$8K |