| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,879 |
1,850 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
2,165 |
2,130 |
$38K |
| D0274 |
Bitewings - four radiographic images |
1,472 |
1,452 |
$34K |
| D1206 |
Topical application of fluoride varnish |
1,448 |
1,427 |
$27K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
280 |
202 |
$25K |
| D1120 |
Prophylaxis - child |
676 |
669 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
161 |
106 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
453 |
367 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
148 |
101 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
15 |
15 |
$0.00 |