| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,138 |
1,117 |
$58K |
| D0120 |
Periodic oral evaluation - established patient |
2,005 |
1,954 |
$46K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,458 |
1,428 |
$26K |
| D1120 |
Prophylaxis - child |
582 |
570 |
$20K |
| D0274 |
Bitewings - four radiographic images |
546 |
533 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
48 |
27 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
134 |
132 |
$4K |
| D0272 |
Bitewings - two radiographic images |
69 |
69 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
66 |
64 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
13 |
$1K |
| D1206 |
Topical application of fluoride varnish |
25 |
25 |
$537.78 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
13 |
$445.63 |