| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,556 |
897 |
$174K |
| D1120 |
Prophylaxis - child |
3,148 |
3,021 |
$91K |
| D0120 |
Periodic oral evaluation - established patient |
4,362 |
4,191 |
$90K |
| D1206 |
Topical application of fluoride varnish |
4,904 |
4,693 |
$82K |
| D1110 |
Prophylaxis - adult |
1,949 |
1,866 |
$76K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
724 |
371 |
$51K |
| D0274 |
Bitewings - four radiographic images |
1,026 |
976 |
$29K |
| D0330 |
Panoramic radiographic image |
482 |
457 |
$25K |
| D0272 |
Bitewings - two radiographic images |
791 |
764 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
317 |
305 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
49 |
47 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
94 |
93 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
13 |
12 |
$126.14 |
| D1999 |
|
681 |
631 |
$0.00 |