| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,442 |
3,436 |
$137K |
| D0120 |
Periodic oral evaluation - established patient |
5,529 |
5,521 |
$111K |
| D4355 |
|
2,005 |
1,997 |
$97K |
| D0274 |
Bitewings - four radiographic images |
2,263 |
2,259 |
$54K |
| D0140 |
Limited oral evaluation - problem focused |
912 |
907 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
147 |
92 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
368 |
367 |
$9K |
| D1120 |
Prophylaxis - child |
221 |
220 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
200 |
198 |
$7K |
| D4341 |
|
34 |
13 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
46 |
27 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
152 |
152 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
133 |
133 |
$1K |