| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,674 |
1,451 |
$70K |
| D0120 |
Periodic oral evaluation - established patient |
1,685 |
1,463 |
$34K |
| D0274 |
Bitewings - four radiographic images |
417 |
365 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
60 |
43 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
55 |
51 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
68 |
64 |
$2K |
| D1120 |
Prophylaxis - child |
46 |
44 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
26 |
25 |
$819.44 |
| D0220 |
Intraoral - periapical first radiographic image |
30 |
28 |
$485.53 |
| D1206 |
Topical application of fluoride varnish |
14 |
14 |
$330.30 |