| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,901 |
3,679 |
$151K |
| D0120 |
Periodic oral evaluation - established patient |
4,301 |
4,010 |
$112K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
810 |
724 |
$53K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,902 |
1,808 |
$47K |
| D1110 |
Prophylaxis - adult |
1,111 |
989 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,389 |
1,302 |
$30K |
| D0210 |
Intraoral - complete series of radiographic images |
658 |
621 |
$19K |
| D0274 |
Bitewings - four radiographic images |
958 |
929 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
148 |
143 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
213 |
200 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
520 |
489 |
$9K |
| D0272 |
Bitewings - two radiographic images |
643 |
611 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
523 |
509 |
$3K |