| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,948 |
1,899 |
$82K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
749 |
460 |
$49K |
| D0210 |
Intraoral - complete series of radiographic images |
883 |
856 |
$48K |
| D2752 |
|
88 |
58 |
$46K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,700 |
1,663 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,255 |
1,218 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
707 |
691 |
$17K |
| D0274 |
Bitewings - four radiographic images |
534 |
522 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
138 |
94 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
457 |
443 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
82 |
61 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
408 |
223 |
$4K |
| D1120 |
Prophylaxis - child |
13 |
13 |
$461.37 |
| D0140 |
Limited oral evaluation - problem focused |
15 |
15 |
$366.00 |