| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,449 |
1,340 |
$62K |
| D0120 |
Periodic oral evaluation - established patient |
2,353 |
2,148 |
$46K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
692 |
287 |
$45K |
| D0140 |
Limited oral evaluation - problem focused |
1,200 |
968 |
$38K |
| D1120 |
Prophylaxis - child |
1,191 |
1,097 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,809 |
1,652 |
$31K |
| D0274 |
Bitewings - four radiographic images |
936 |
839 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
567 |
503 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
854 |
672 |
$8K |
| D0272 |
Bitewings - two radiographic images |
159 |
142 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
50 |
26 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
24 |
13 |
$2K |
| D0330 |
Panoramic radiographic image |
43 |
42 |
$2K |
| D1999 |
|
236 |
194 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
134 |
72 |
$1K |