| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,649 |
6,413 |
$338K |
| D0120 |
Periodic oral evaluation - established patient |
7,030 |
6,803 |
$155K |
| D0274 |
Bitewings - four radiographic images |
2,517 |
2,439 |
$86K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
601 |
460 |
$48K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
516 |
394 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,422 |
1,383 |
$40K |
| D0210 |
Intraoral - complete series of radiographic images |
514 |
487 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
2,061 |
1,930 |
$30K |
| D1120 |
Prophylaxis - child |
335 |
321 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
272 |
191 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
208 |
193 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
611 |
359 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
39 |
36 |
$1K |
| D0272 |
Bitewings - two radiographic images |
14 |
13 |
$326.00 |