| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,400 |
1,340 |
$43K |
| D0120 |
Periodic oral evaluation - established patient |
1,806 |
1,735 |
$42K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
672 |
413 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,865 |
1,803 |
$37K |
| D1120 |
Prophylaxis - child |
817 |
794 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,192 |
1,145 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
721 |
682 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
250 |
244 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
186 |
132 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
203 |
196 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
326 |
305 |
$3K |