| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,649 |
2,584 |
$140K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,270 |
437 |
$126K |
| D0274 |
Bitewings - four radiographic images |
2,108 |
2,065 |
$76K |
| D0120 |
Periodic oral evaluation - established patient |
2,447 |
2,407 |
$58K |
| D0220 |
Intraoral - periapical first radiographic image |
3,150 |
3,041 |
$49K |
| D0140 |
Limited oral evaluation - problem focused |
1,107 |
1,083 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
992 |
960 |
$42K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,037 |
2,583 |
$39K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,087 |
1,079 |
$32K |
| D1120 |
Prophylaxis - child |
553 |
549 |
$29K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
196 |
62 |
$19K |
| D0330 |
Panoramic radiographic image |
90 |
88 |
$6K |
| D2330 |
|
43 |
12 |
$3K |
| D2331 |
|
39 |
12 |
$3K |