| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,991 |
1,648 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
2,623 |
2,172 |
$46K |
| D1206 |
Topical application of fluoride varnish |
1,801 |
1,481 |
$30K |
| D0274 |
Bitewings - four radiographic images |
653 |
538 |
$19K |
| D1120 |
Prophylaxis - child |
486 |
426 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
31 |
13 |
$2K |
| D0330 |
Panoramic radiographic image |
37 |
28 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
35 |
33 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
17 |
17 |
$698.53 |
| D0272 |
Bitewings - two radiographic images |
26 |
26 |
$652.50 |
| D0140 |
Limited oral evaluation - problem focused |
16 |
13 |
$448.66 |