| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
890 |
883 |
$79K |
| D0120 |
Periodic oral evaluation - established patient |
928 |
917 |
$75K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
886 |
403 |
$59K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
853 |
846 |
$56K |
| D4910 |
|
507 |
499 |
$37K |
| D0210 |
Intraoral - complete series of radiographic images |
637 |
632 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,631 |
1,610 |
$23K |
| D1120 |
Prophylaxis - child |
408 |
399 |
$20K |
| D0274 |
Bitewings - four radiographic images |
939 |
929 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
145 |
87 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,407 |
1,188 |
$10K |
| D4341 |
|
122 |
31 |
$8K |
| D9430 |
|
140 |
132 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
114 |
108 |
$1K |