| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,282 |
2,210 |
$102K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,102 |
3,008 |
$84K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,229 |
831 |
$69K |
| D0274 |
Bitewings - four radiographic images |
1,650 |
1,589 |
$44K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
641 |
462 |
$40K |
| D2335 |
|
432 |
200 |
$30K |
| D2394 |
|
415 |
249 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
2,633 |
2,517 |
$22K |
| D1120 |
Prophylaxis - child |
423 |
412 |
$19K |
| D9110 |
|
726 |
700 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,136 |
1,104 |
$16K |
| D2332 |
|
135 |
85 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,318 |
724 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
78 |
78 |
$5K |
| D0272 |
Bitewings - two radiographic images |
166 |
164 |
$3K |