| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,346 |
4,326 |
$146K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,096 |
2,496 |
$61K |
| D1999 |
|
3,825 |
3,299 |
$54K |
| D0272 |
Bitewings - two radiographic images |
3,326 |
2,717 |
$48K |
| D0120 |
Periodic oral evaluation - established patient |
2,841 |
2,371 |
$39K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,666 |
1,295 |
$23K |
| D1120 |
Prophylaxis - child |
385 |
313 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
851 |
762 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
270 |
196 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
31 |
13 |
$727.00 |