| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,384 |
2,271 |
$117K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,239 |
774 |
$85K |
| D0120 |
Periodic oral evaluation - established patient |
2,573 |
2,439 |
$56K |
| D0274 |
Bitewings - four radiographic images |
1,679 |
1,602 |
$54K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
667 |
449 |
$51K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
793 |
483 |
$45K |
| D0330 |
Panoramic radiographic image |
864 |
832 |
$36K |
| D1120 |
Prophylaxis - child |
627 |
603 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
662 |
642 |
$27K |
| D1206 |
Topical application of fluoride varnish |
961 |
924 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
799 |
734 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
228 |
212 |
$8K |