| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,660 |
1,524 |
$85K |
| D0120 |
Periodic oral evaluation - established patient |
1,412 |
1,299 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
708 |
662 |
$27K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
348 |
203 |
$25K |
| D0210 |
Intraoral - complete series of radiographic images |
293 |
270 |
$21K |
| D0274 |
Bitewings - four radiographic images |
566 |
521 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
892 |
836 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
335 |
298 |
$12K |
| D1351 |
Sealant - per tooth |
454 |
54 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
450 |
393 |
$5K |
| D1120 |
Prophylaxis - child |
122 |
110 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15 |
12 |
$816.90 |