| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,454 |
2,411 |
$108K |
| D0120 |
Periodic oral evaluation - established patient |
2,341 |
2,303 |
$44K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,412 |
1,379 |
$23K |
| D0274 |
Bitewings - four radiographic images |
1,639 |
1,606 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
328 |
327 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
212 |
138 |
$14K |
| D1120 |
Prophylaxis - child |
271 |
271 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
764 |
730 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
229 |
226 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
12 |
$1K |