| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,768 |
1,739 |
$67K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
542 |
378 |
$48K |
| D0120 |
Periodic oral evaluation - established patient |
1,749 |
1,724 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
904 |
828 |
$23K |
| D0274 |
Bitewings - four radiographic images |
987 |
968 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,877 |
1,737 |
$17K |
| D1120 |
Prophylaxis - child |
429 |
426 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
195 |
134 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
510 |
508 |
$12K |
| D0330 |
Panoramic radiographic image |
276 |
272 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
296 |
293 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,663 |
1,336 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
61 |
52 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
59 |
38 |
$2K |
| D1351 |
Sealant - per tooth |
45 |
15 |
$1K |