| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,307 |
2,136 |
$111K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
978 |
525 |
$79K |
| D0120 |
Periodic oral evaluation - established patient |
2,168 |
2,008 |
$44K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
563 |
344 |
$40K |
| D0274 |
Bitewings - four radiographic images |
1,114 |
1,032 |
$36K |
| D0210 |
Intraoral - complete series of radiographic images |
573 |
528 |
$36K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
524 |
270 |
$29K |
| D2394 |
|
216 |
137 |
$22K |
| D1206 |
Topical application of fluoride varnish |
693 |
645 |
$16K |
| D1120 |
Prophylaxis - child |
285 |
271 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
200 |
191 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
544 |
492 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
154 |
145 |
$6K |
| D2332 |
|
46 |
26 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
141 |
138 |
$4K |
| D1351 |
Sealant - per tooth |
73 |
12 |
$2K |
| D1999 |
|
147 |
116 |
$0.00 |