| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,152 |
2,038 |
$103K |
| D0120 |
Periodic oral evaluation - established patient |
2,380 |
2,248 |
$54K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
754 |
463 |
$50K |
| D0274 |
Bitewings - four radiographic images |
733 |
694 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
706 |
686 |
$13K |
| D1206 |
Topical application of fluoride varnish |
461 |
434 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
224 |
213 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
117 |
71 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
86 |
69 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
198 |
180 |
$2K |
| D1120 |
Prophylaxis - child |
75 |
72 |
$2K |
| D0272 |
Bitewings - two radiographic images |
42 |
41 |
$987.40 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$499.08 |