| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,094 |
1,079 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
2,003 |
1,989 |
$35K |
| D1120 |
Prophylaxis - child |
1,192 |
1,191 |
$34K |
| D1206 |
Topical application of fluoride varnish |
1,796 |
1,777 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
488 |
488 |
$10K |
| D0274 |
Bitewings - four radiographic images |
221 |
221 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
148 |
148 |
$3K |
| D0272 |
Bitewings - two radiographic images |
136 |
136 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
75 |
73 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
19 |
12 |
$0.00 |