| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,140 |
1,119 |
$62K |
| D0120 |
Periodic oral evaluation - established patient |
1,438 |
1,414 |
$39K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,134 |
1,115 |
$26K |
| D0274 |
Bitewings - four radiographic images |
719 |
700 |
$15K |
| D1120 |
Prophylaxis - child |
201 |
199 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
75 |
75 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$118.20 |