| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
474 |
461 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
314 |
289 |
$13K |
| D1206 |
Topical application of fluoride varnish |
486 |
477 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
334 |
330 |
$9K |
| D0274 |
Bitewings - four radiographic images |
219 |
214 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
102 |
99 |
$7K |
| D1120 |
Prophylaxis - child |
109 |
107 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
24 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
80 |
74 |
$986.18 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$421.44 |