| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,453 |
1,390 |
$43K |
| D0120 |
Periodic oral evaluation - established patient |
1,670 |
1,591 |
$25K |
| D0274 |
Bitewings - four radiographic images |
337 |
321 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
76 |
50 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
92 |
82 |
$1K |
| D1120 |
Prophylaxis - child |
47 |
45 |
$880.00 |
| D1206 |
Topical application of fluoride varnish |
37 |
36 |
$540.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13 |
12 |
$342.55 |
| D0220 |
Intraoral - periapical first radiographic image |
19 |
12 |
$55.00 |