| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,198 |
2,110 |
$77K |
| D0120 |
Periodic oral evaluation - established patient |
3,289 |
3,174 |
$60K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,816 |
3,661 |
$54K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
822 |
492 |
$50K |
| D1120 |
Prophylaxis - child |
1,713 |
1,650 |
$46K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
360 |
231 |
$26K |
| D0272 |
Bitewings - two radiographic images |
1,474 |
1,409 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
387 |
374 |
$9K |
| D0274 |
Bitewings - four radiographic images |
294 |
279 |
$6K |
| D1999 |
|
403 |
316 |
$4K |
| D0330 |
Panoramic radiographic image |
43 |
41 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
64 |
60 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
48 |
45 |
$519.75 |