| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,234 |
1,170 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
548 |
518 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
268 |
166 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
361 |
310 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
735 |
698 |
$16K |
| D0274 |
Bitewings - four radiographic images |
426 |
395 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
279 |
270 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
57 |
44 |
$5K |
| D1206 |
Topical application of fluoride varnish |
391 |
372 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
410 |
362 |
$4K |
| D0330 |
Panoramic radiographic image |
99 |
91 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
23 |
17 |
$1K |