| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,641 |
4,626 |
$165K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,661 |
1,660 |
$125K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,843 |
1,843 |
$107K |
| D0120 |
Periodic oral evaluation - established patient |
4,587 |
4,572 |
$92K |
| D0274 |
Bitewings - four radiographic images |
2,419 |
2,416 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
4,011 |
3,951 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,544 |
3,505 |
$32K |
| D0210 |
Intraoral - complete series of radiographic images |
1,668 |
1,657 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,245 |
1,240 |
$25K |
| D1120 |
Prophylaxis - child |
814 |
810 |
$25K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
650 |
537 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,790 |
1,781 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
314 |
311 |
$3K |
| D1999 |
|
185 |
168 |
$0.00 |