| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,000 |
929 |
$35K |
| D0120 |
Periodic oral evaluation - established patient |
985 |
918 |
$19K |
| D0274 |
Bitewings - four radiographic images |
454 |
411 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
158 |
80 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
155 |
86 |
$9K |
| D0330 |
Panoramic radiographic image |
232 |
205 |
$8K |
| D9110 |
|
283 |
256 |
$8K |
| D2331 |
|
57 |
26 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
158 |
127 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
138 |
124 |
$3K |
| D1330 |
|
263 |
213 |
$3K |
| D1310 |
|
261 |
212 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
39 |
27 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
232 |
199 |
$2K |
| D2330 |
|
32 |
13 |
$1K |
| D1120 |
Prophylaxis - child |
25 |
25 |
$750.00 |