| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,613 |
1,579 |
$39K |
| D1110 |
Prophylaxis - adult |
755 |
737 |
$27K |
| D1120 |
Prophylaxis - child |
653 |
645 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
218 |
111 |
$15K |
| D1206 |
Topical application of fluoride varnish |
624 |
618 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
234 |
226 |
$8K |
| D0274 |
Bitewings - four radiographic images |
269 |
262 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
61 |
37 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
264 |
244 |
$4K |
| D0272 |
Bitewings - two radiographic images |
81 |
81 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
36 |
36 |
$1K |