| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,472 |
1,462 |
$48K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
637 |
470 |
$37K |
| D0274 |
Bitewings - four radiographic images |
1,206 |
1,197 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
1,388 |
1,375 |
$27K |
| D9110 |
|
601 |
585 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,819 |
1,769 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,617 |
1,586 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
230 |
188 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
351 |
350 |
$7K |
| D0330 |
Panoramic radiographic image |
184 |
178 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
73 |
60 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
74 |
74 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
54 |
52 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
61 |
60 |
$991.21 |
| D1120 |
Prophylaxis - child |
15 |
15 |
$294.28 |
| D0602 |
|
12 |
12 |
$110.00 |
| D1330 |
|
12 |
12 |
$64.20 |