| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,040 |
2,020 |
$78K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,826 |
1,796 |
$55K |
| D1120 |
Prophylaxis - child |
2,212 |
2,179 |
$51K |
| D0120 |
Periodic oral evaluation - established patient |
2,516 |
2,496 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,674 |
2,637 |
$46K |
| D0274 |
Bitewings - four radiographic images |
1,277 |
1,264 |
$28K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
67 |
28 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
146 |
140 |
$4K |
| D0272 |
Bitewings - two radiographic images |
107 |
107 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20 |
14 |
$1K |