| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,077 |
1,034 |
$54K |
| D0120 |
Periodic oral evaluation - established patient |
1,248 |
1,200 |
$35K |
| D1120 |
Prophylaxis - child |
907 |
870 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,167 |
1,132 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
195 |
194 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
149 |
148 |
$9K |
| D0272 |
Bitewings - two radiographic images |
337 |
329 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
353 |
335 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
23 |
15 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
153 |
139 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
32 |
24 |
$2K |
| D1206 |
Topical application of fluoride varnish |
14 |
14 |
$315.77 |