| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,608 |
1,564 |
$59K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
806 |
467 |
$53K |
| D0274 |
Bitewings - four radiographic images |
1,654 |
1,614 |
$37K |
| D0350 |
|
3,815 |
809 |
$35K |
| D0120 |
Periodic oral evaluation - established patient |
1,756 |
1,716 |
$33K |
| D1320 |
|
1,772 |
1,739 |
$32K |
| D1321 |
|
1,651 |
1,618 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,279 |
1,261 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
526 |
513 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,846 |
903 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,433 |
1,367 |
$8K |
| D1120 |
Prophylaxis - child |
368 |
365 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
33 |
26 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
13 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
33 |
28 |
$519.34 |
| D0272 |
Bitewings - two radiographic images |
28 |
28 |
$375.80 |
| D0180 |
|
13 |
12 |
$263.50 |