| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
945 |
906 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
1,082 |
1,045 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
749 |
668 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
566 |
539 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
211 |
113 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
564 |
557 |
$8K |
| D0274 |
Bitewings - four radiographic images |
405 |
397 |
$7K |
| D1120 |
Prophylaxis - child |
397 |
386 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
153 |
146 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
69 |
43 |
$4K |
| D0330 |
Panoramic radiographic image |
83 |
81 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
29 |
16 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
222 |
188 |
$895.00 |