| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,668 |
2,630 |
$100K |
| D0120 |
Periodic oral evaluation - established patient |
3,544 |
3,497 |
$89K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
661 |
463 |
$70K |
| D0140 |
Limited oral evaluation - problem focused |
1,435 |
1,372 |
$51K |
| D0274 |
Bitewings - four radiographic images |
1,464 |
1,431 |
$43K |
| D1120 |
Prophylaxis - child |
1,474 |
1,454 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
2,475 |
2,386 |
$36K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
271 |
205 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,592 |
1,320 |
$34K |
| D1206 |
Topical application of fluoride varnish |
1,685 |
1,665 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
640 |
628 |
$27K |
| D0330 |
Panoramic radiographic image |
325 |
317 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
53 |
37 |
$4K |
| D0272 |
Bitewings - two radiographic images |
215 |
214 |
$4K |
| D9110 |
|
28 |
26 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
48 |
48 |
$754.56 |