| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1208 |
Topical application of fluoride, excluding varnish |
640 |
611 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
448 |
426 |
$10K |
| D1120 |
Prophylaxis - child |
262 |
240 |
$10K |
| D1110 |
Prophylaxis - adult |
295 |
290 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
154 |
142 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
45 |
26 |
$4K |
| D0274 |
Bitewings - four radiographic images |
93 |
91 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
36 |
25 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
53 |
52 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
31 |
31 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
70 |
68 |
$776.72 |