| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,347 |
1,199 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
1,274 |
1,151 |
$19K |
| D0274 |
Bitewings - four radiographic images |
749 |
664 |
$13K |
| D1206 |
Topical application of fluoride varnish |
520 |
466 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
105 |
98 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
118 |
110 |
$3K |
| D0330 |
Panoramic radiographic image |
34 |
34 |
$1K |
| D1120 |
Prophylaxis - child |
72 |
70 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
24 |
12 |
$700.14 |
| D0220 |
Intraoral - periapical first radiographic image |
90 |
71 |
$354.90 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$293.54 |