| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,207 |
2,160 |
$79K |
| D0120 |
Periodic oral evaluation - established patient |
2,451 |
2,394 |
$46K |
| D0274 |
Bitewings - four radiographic images |
1,211 |
1,199 |
$27K |
| D1206 |
Topical application of fluoride varnish |
844 |
838 |
$15K |
| D1120 |
Prophylaxis - child |
380 |
363 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
354 |
343 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
137 |
95 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
187 |
187 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
69 |
49 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
536 |
518 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
71 |
66 |
$943.50 |