| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,261 |
1,170 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
1,209 |
1,145 |
$26K |
| D0274 |
Bitewings - four radiographic images |
591 |
558 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
95 |
43 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
172 |
155 |
$6K |
| D1120 |
Prophylaxis - child |
52 |
50 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
62 |
54 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
46 |
43 |
$1K |