| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,454 |
4,289 |
$201K |
| D0120 |
Periodic oral evaluation - established patient |
4,944 |
4,730 |
$104K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
751 |
584 |
$51K |
| D0274 |
Bitewings - four radiographic images |
1,049 |
1,018 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
1,275 |
1,187 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,807 |
1,712 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
583 |
443 |
$28K |
| D0272 |
Bitewings - two radiographic images |
1,341 |
1,283 |
$26K |
| D0210 |
Intraoral - complete series of radiographic images |
352 |
335 |
$19K |
| D1120 |
Prophylaxis - child |
531 |
506 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
384 |
367 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
785 |
715 |
$7K |
| D2330 |
|
70 |
48 |
$3K |
| D2331 |
|
17 |
12 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
12 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
37 |
25 |
$377.00 |