| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2335 |
|
1,733 |
1,081 |
$174K |
| D1110 |
Prophylaxis - adult |
3,662 |
3,655 |
$124K |
| D0120 |
Periodic oral evaluation - established patient |
4,856 |
4,851 |
$95K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,087 |
1,257 |
$82K |
| D0274 |
Bitewings - four radiographic images |
3,892 |
3,890 |
$74K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
837 |
637 |
$51K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,425 |
2,423 |
$18K |
| D2330 |
|
412 |
233 |
$16K |
| D1120 |
Prophylaxis - child |
512 |
511 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,009 |
1,008 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
875 |
873 |
$8K |
| D2394 |
|
108 |
102 |
$7K |
| D1351 |
Sealant - per tooth |
72 |
39 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
54 |
51 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
367 |
366 |
$4K |