| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0240 |
|
856 |
411 |
$13K |
| D1120 |
Prophylaxis - child |
565 |
531 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
181 |
100 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
720 |
685 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
904 |
844 |
$9K |
| D0330 |
Panoramic radiographic image |
273 |
248 |
$8K |
| D1110 |
Prophylaxis - adult |
271 |
256 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
124 |
69 |
$6K |
| D0272 |
Bitewings - two radiographic images |
443 |
416 |
$6K |
| D0274 |
Bitewings - four radiographic images |
190 |
182 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
179 |
158 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
27 |
26 |
$667.00 |