| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,674 |
1,573 |
$83K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
897 |
419 |
$70K |
| D0120 |
Periodic oral evaluation - established patient |
1,614 |
1,506 |
$38K |
| D0210 |
Intraoral - complete series of radiographic images |
571 |
529 |
$37K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
264 |
148 |
$26K |
| D0274 |
Bitewings - four radiographic images |
730 |
681 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
591 |
548 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
941 |
842 |
$11K |
| D1206 |
Topical application of fluoride varnish |
785 |
728 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
590 |
494 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
94 |
82 |
$3K |
| D4346 |
|
14 |
14 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
25 |
12 |
$1K |
| D0330 |
Panoramic radiographic image |
42 |
38 |
$1K |
| D1120 |
Prophylaxis - child |
25 |
24 |
$724.50 |
| D4910 |
|
13 |
12 |
$625.80 |