| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,942 |
1,847 |
$87K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
891 |
513 |
$62K |
| D0120 |
Periodic oral evaluation - established patient |
1,997 |
1,905 |
$43K |
| D0274 |
Bitewings - four radiographic images |
732 |
687 |
$24K |
| D0330 |
Panoramic radiographic image |
134 |
127 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
200 |
193 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
367 |
340 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
122 |
114 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
52 |
38 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
87 |
78 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
12 |
$1K |
| D1120 |
Prophylaxis - child |
13 |
12 |
$310.50 |
| D2330 |
|
15 |
12 |
$102.93 |