| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
773 |
693 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
506 |
464 |
$29K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
216 |
152 |
$25K |
| D1120 |
Prophylaxis - child |
474 |
421 |
$22K |
| D0274 |
Bitewings - four radiographic images |
427 |
358 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
134 |
79 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
143 |
135 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
240 |
208 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
256 |
223 |
$6K |
| D1206 |
Topical application of fluoride varnish |
132 |
132 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
50 |
48 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
14 |
13 |
$310.24 |