| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,105 |
1,091 |
$39K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
337 |
227 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
941 |
930 |
$19K |
| D0274 |
Bitewings - four radiographic images |
255 |
244 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
147 |
146 |
$7K |
| D1330 |
|
641 |
637 |
$6K |
| D1310 |
|
640 |
636 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
221 |
218 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
84 |
51 |
$4K |
| D1206 |
Topical application of fluoride varnish |
173 |
165 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
31 |
25 |
$2K |
| D1120 |
Prophylaxis - child |
50 |
49 |
$2K |
| D9110 |
|
18 |
14 |
$540.00 |
| D0220 |
Intraoral - periapical first radiographic image |
39 |
39 |
$312.00 |