| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,117 |
981 |
$57K |
| D0274 |
Bitewings - four radiographic images |
1,086 |
956 |
$38K |
| D0120 |
Periodic oral evaluation - established patient |
1,623 |
1,430 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
860 |
758 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
665 |
594 |
$11K |
| D1120 |
Prophylaxis - child |
146 |
126 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
286 |
255 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
24 |
12 |
$1K |
| D2160 |
|
13 |
12 |
$1K |