| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,348 |
420 |
$83K |
| D1110 |
Prophylaxis - adult |
1,894 |
1,768 |
$64K |
| D0120 |
Periodic oral evaluation - established patient |
3,500 |
3,266 |
$62K |
| D1120 |
Prophylaxis - child |
1,951 |
1,820 |
$52K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
643 |
265 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,899 |
2,710 |
$40K |
| D1999 |
|
1,937 |
1,610 |
$32K |
| D0330 |
Panoramic radiographic image |
454 |
401 |
$19K |
| D0274 |
Bitewings - four radiographic images |
445 |
417 |
$10K |
| D0272 |
Bitewings - two radiographic images |
157 |
140 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
62 |
58 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
28 |
27 |
$287.05 |