| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,256 |
1,252 |
$42K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
639 |
432 |
$36K |
| D0274 |
Bitewings - four radiographic images |
817 |
814 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
1,098 |
1,095 |
$20K |
| D9920 |
|
132 |
130 |
$16K |
| D4346 |
|
368 |
367 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
243 |
196 |
$15K |
| D0330 |
Panoramic radiographic image |
322 |
321 |
$11K |
| D1330 |
|
785 |
783 |
$9K |
| D1310 |
|
785 |
783 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
386 |
385 |
$7K |
| D1206 |
Topical application of fluoride varnish |
339 |
339 |
$6K |
| D1320 |
|
278 |
269 |
$5K |
| D2332 |
|
60 |
40 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
66 |
50 |
$3K |
| D1120 |
Prophylaxis - child |
98 |
98 |
$3K |
| D9110 |
|
101 |
92 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
195 |
193 |
$1K |
| D2331 |
|
17 |
13 |
$654.00 |