| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,780 |
1,201 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
1,335 |
959 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
582 |
373 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
404 |
247 |
$16K |
| D0274 |
Bitewings - four radiographic images |
167 |
101 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
252 |
209 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
20 |
13 |
$960.06 |
| D1999 |
|
142 |
91 |
$5.00 |