| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,149 |
2,073 |
$79K |
| D0120 |
Periodic oral evaluation - established patient |
2,941 |
2,826 |
$71K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,889 |
1,806 |
$30K |
| D0274 |
Bitewings - four radiographic images |
855 |
818 |
$25K |
| D1120 |
Prophylaxis - child |
716 |
670 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
154 |
110 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
52 |
38 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
55 |
53 |
$2K |
| D0330 |
Panoramic radiographic image |
31 |
31 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
58 |
54 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
116 |
108 |
$2K |
| D0272 |
Bitewings - two radiographic images |
76 |
69 |
$1K |