| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,253 |
2,113 |
$96K |
| D0120 |
Periodic oral evaluation - established patient |
2,948 |
2,764 |
$61K |
| D0274 |
Bitewings - four radiographic images |
965 |
896 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,322 |
1,226 |
$23K |
| D1120 |
Prophylaxis - child |
728 |
686 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
147 |
131 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
16 |
12 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
14 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
83 |
65 |
$840.72 |
| D0272 |
Bitewings - two radiographic images |
19 |
13 |
$306.53 |