| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,079 |
921 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
1,118 |
992 |
$45K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
161 |
98 |
$25K |
| D0274 |
Bitewings - four radiographic images |
373 |
307 |
$17K |
| D1206 |
Topical application of fluoride varnish |
676 |
579 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
246 |
227 |
$14K |
| D1120 |
Prophylaxis - child |
230 |
204 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
397 |
343 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
178 |
149 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
235 |
215 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
42 |
25 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
35 |
24 |
$2K |
| D0330 |
Panoramic radiographic image |
24 |
13 |
$1K |