| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,902 |
2,723 |
$108K |
| D0120 |
Periodic oral evaluation - established patient |
3,174 |
2,993 |
$60K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
340 |
247 |
$19K |
| D1120 |
Prophylaxis - child |
787 |
759 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
928 |
894 |
$16K |
| D0274 |
Bitewings - four radiographic images |
518 |
480 |
$11K |
| D0272 |
Bitewings - two radiographic images |
650 |
628 |
$8K |
| D0330 |
Panoramic radiographic image |
68 |
64 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
52 |
39 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
65 |
63 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
52 |
40 |
$790.30 |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$30.00 |