| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,331 |
1,275 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
1,794 |
1,725 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,260 |
1,225 |
$28K |
| D1120 |
Prophylaxis - child |
605 |
589 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
229 |
201 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
112 |
73 |
$6K |
| D0272 |
Bitewings - two radiographic images |
237 |
226 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
54 |
38 |
$3K |
| D0274 |
Bitewings - four radiographic images |
69 |
67 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
60 |
57 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
14 |
13 |
$178.90 |