| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,489 |
1,449 |
$79K |
| D1120 |
Prophylaxis - child |
1,925 |
1,852 |
$72K |
| D0120 |
Periodic oral evaluation - established patient |
2,039 |
1,991 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,216 |
1,146 |
$56K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
382 |
228 |
$46K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,924 |
1,859 |
$41K |
| D0210 |
Intraoral - complete series of radiographic images |
459 |
432 |
$27K |
| D0272 |
Bitewings - two radiographic images |
1,063 |
1,041 |
$26K |
| D1206 |
Topical application of fluoride varnish |
629 |
616 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
173 |
111 |
$14K |
| D0330 |
Panoramic radiographic image |
166 |
158 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
43 |
26 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
72 |
72 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
26 |
24 |
$929.79 |
| D0220 |
Intraoral - periapical first radiographic image |
41 |
41 |
$815.49 |