| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
686 |
649 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
651 |
612 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
225 |
206 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
511 |
489 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
345 |
335 |
$6K |
| D1120 |
Prophylaxis - child |
162 |
153 |
$3K |
| D0274 |
Bitewings - four radiographic images |
118 |
108 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
33 |
13 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
34 |
32 |
$745.14 |
| D0220 |
Intraoral - periapical first radiographic image |
19 |
16 |
$90.00 |