| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,249 |
1,171 |
$48K |
| D0120 |
Periodic oral evaluation - established patient |
1,549 |
1,440 |
$30K |
| D0274 |
Bitewings - four radiographic images |
485 |
436 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
114 |
70 |
$11K |
| D1120 |
Prophylaxis - child |
361 |
337 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
179 |
157 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
320 |
307 |
$5K |
| D1206 |
Topical application of fluoride varnish |
204 |
175 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
61 |
58 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
20 |
12 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
86 |
80 |
$425.00 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$176.85 |