| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,221 |
2,205 |
$76K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
707 |
482 |
$51K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
492 |
348 |
$41K |
| D1354 |
|
2,585 |
571 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
2,007 |
1,998 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,245 |
2,234 |
$32K |
| D0210 |
Intraoral - complete series of radiographic images |
421 |
413 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
662 |
652 |
$14K |
| D0274 |
Bitewings - four radiographic images |
737 |
735 |
$12K |
| D1120 |
Prophylaxis - child |
254 |
252 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
76 |
63 |
$4K |
| D2394 |
|
17 |
14 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
40 |
40 |
$1K |