| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
246 |
219 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
456 |
426 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
141 |
100 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
373 |
345 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
176 |
156 |
$7K |
| D1120 |
Prophylaxis - child |
172 |
162 |
$6K |
| D0274 |
Bitewings - four radiographic images |
181 |
167 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
39 |
13 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
206 |
188 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
144 |
129 |
$2K |