| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,232 |
1,221 |
$50K |
| D0120 |
Periodic oral evaluation - established patient |
1,644 |
1,632 |
$37K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
307 |
282 |
$29K |
| D0274 |
Bitewings - four radiographic images |
942 |
939 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
208 |
187 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,382 |
1,377 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
672 |
667 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,476 |
1,466 |
$12K |
| D1120 |
Prophylaxis - child |
237 |
237 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
415 |
415 |
$6K |