| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
956 |
926 |
$50K |
| D0120 |
Periodic oral evaluation - established patient |
1,109 |
1,072 |
$26K |
| D0274 |
Bitewings - four radiographic images |
455 |
447 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
420 |
417 |
$12K |
| D1120 |
Prophylaxis - child |
172 |
170 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
48 |
44 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
41 |
40 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
13 |
12 |
$890.86 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12 |
12 |
$735.69 |