| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,890 |
1,845 |
$118K |
| D0120 |
Periodic oral evaluation - established patient |
2,119 |
2,073 |
$62K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,110 |
2,070 |
$49K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
151 |
93 |
$19K |
| D1120 |
Prophylaxis - child |
385 |
372 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
209 |
203 |
$13K |
| D0274 |
Bitewings - four radiographic images |
392 |
377 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
118 |
115 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
65 |
64 |
$3K |
| D1351 |
Sealant - per tooth |
80 |
12 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
132 |
127 |
$2K |
| D1330 |
|
66 |
66 |
$396.00 |