| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,076 |
3,031 |
$153K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,068 |
643 |
$98K |
| D0120 |
Periodic oral evaluation - established patient |
2,939 |
2,903 |
$65K |
| D0330 |
Panoramic radiographic image |
898 |
886 |
$42K |
| D0274 |
Bitewings - four radiographic images |
1,241 |
1,226 |
$33K |
| D0272 |
Bitewings - two radiographic images |
1,585 |
1,552 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
286 |
209 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,162 |
1,139 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
440 |
437 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
369 |
360 |
$15K |
| D1120 |
Prophylaxis - child |
254 |
244 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
46 |
36 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
405 |
401 |
$5K |
| D1206 |
Topical application of fluoride varnish |
286 |
275 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
28 |
25 |
$287.77 |