| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,485 |
1,421 |
$72K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
377 |
252 |
$46K |
| D1206 |
Topical application of fluoride varnish |
2,370 |
2,288 |
$45K |
| D0120 |
Periodic oral evaluation - established patient |
1,859 |
1,812 |
$43K |
| D4910 |
|
639 |
626 |
$42K |
| D0274 |
Bitewings - four radiographic images |
953 |
933 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
228 |
148 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
226 |
216 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
34 |
28 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
418 |
112 |
$3K |
| D0330 |
Panoramic radiographic image |
41 |
40 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
31 |
29 |
$2K |
| D1320 |
|
15 |
14 |
$534.52 |
| D0602 |
|
116 |
115 |
$214.57 |
| D0601 |
|
12 |
12 |
$31.23 |