| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,866 |
1,681 |
$77K |
| D0120 |
Periodic oral evaluation - established patient |
2,176 |
1,967 |
$42K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
561 |
341 |
$34K |
| D1206 |
Topical application of fluoride varnish |
1,543 |
1,364 |
$27K |
| D0274 |
Bitewings - four radiographic images |
742 |
657 |
$22K |
| D1120 |
Prophylaxis - child |
602 |
536 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
371 |
307 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
110 |
82 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
91 |
85 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
33 |
26 |
$3K |
| D0272 |
Bitewings - two radiographic images |
97 |
89 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
14 |
14 |
$522.80 |
| D1208 |
Topical application of fluoride, excluding varnish |
29 |
26 |
$67.17 |