| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,390 |
2,379 |
$104K |
| D0120 |
Periodic oral evaluation - established patient |
1,997 |
1,987 |
$43K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
272 |
224 |
$21K |
| D0274 |
Bitewings - four radiographic images |
933 |
932 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
924 |
910 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
357 |
356 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
175 |
172 |
$7K |
| D9110 |
|
249 |
245 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
36 |
31 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
105 |
105 |
$979.88 |
| D1120 |
Prophylaxis - child |
15 |
15 |
$482.40 |
| D1208 |
Topical application of fluoride, excluding varnish |
35 |
35 |
$359.70 |