| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,492 |
3,478 |
$90K |
| D0120 |
Periodic oral evaluation - established patient |
4,004 |
3,981 |
$54K |
| D0274 |
Bitewings - four radiographic images |
1,683 |
1,678 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
555 |
551 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
407 |
275 |
$18K |
| D1120 |
Prophylaxis - child |
325 |
320 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
573 |
568 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
170 |
170 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
310 |
304 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
18 |
15 |
$901.91 |
| D0220 |
Intraoral - periapical first radiographic image |
159 |
156 |
$420.93 |