| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9920 |
|
1,500 |
1,307 |
$48K |
| D1110 |
Prophylaxis - adult |
925 |
919 |
$30K |
| D0274 |
Bitewings - four radiographic images |
993 |
991 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
889 |
883 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
281 |
171 |
$15K |
| D9110 |
|
484 |
474 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
200 |
119 |
$9K |
| D0330 |
Panoramic radiographic image |
171 |
169 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
981 |
974 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
589 |
584 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
366 |
364 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
133 |
133 |
$3K |
| D1330 |
|
316 |
314 |
$2K |
| D1120 |
Prophylaxis - child |
46 |
45 |
$1K |
| D0601 |
|
109 |
109 |
$1K |
| D1310 |
|
152 |
150 |
$879.21 |