| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,384 |
1,349 |
$56K |
| D0120 |
Periodic oral evaluation - established patient |
1,684 |
1,624 |
$39K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
409 |
282 |
$28K |
| D8670 |
Periodic orthodontic treatment visit |
227 |
213 |
$24K |
| D0274 |
Bitewings - four radiographic images |
740 |
717 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
397 |
262 |
$22K |
| D1120 |
Prophylaxis - child |
462 |
437 |
$15K |
| D1206 |
Topical application of fluoride varnish |
642 |
614 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
243 |
237 |
$10K |
| D0330 |
Panoramic radiographic image |
251 |
244 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
391 |
384 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
144 |
141 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
74 |
58 |
$5K |
| D2331 |
|
40 |
26 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
310 |
299 |
$3K |
| D2332 |
|
34 |
24 |
$2K |
| D2335 |
|
16 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
28 |
28 |
$474.40 |
| D1999 |
|
775 |
639 |
$60.00 |