| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,559 |
2,380 |
$124K |
| D0120 |
Periodic oral evaluation - established patient |
2,103 |
1,963 |
$49K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
646 |
371 |
$48K |
| D0274 |
Bitewings - four radiographic images |
1,246 |
1,155 |
$44K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
587 |
308 |
$36K |
| D1206 |
Topical application of fluoride varnish |
1,205 |
1,108 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
621 |
563 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
186 |
169 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
217 |
206 |
$9K |
| D1120 |
Prophylaxis - child |
178 |
153 |
$5K |
| D0330 |
Panoramic radiographic image |
70 |
67 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
31 |
24 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
97 |
94 |
$1K |