| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,224 |
1,219 |
$58K |
| D0120 |
Periodic oral evaluation - established patient |
1,400 |
1,395 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
923 |
920 |
$18K |
| D1120 |
Prophylaxis - child |
501 |
500 |
$17K |
| D0272 |
Bitewings - two radiographic images |
745 |
744 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
301 |
298 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
141 |
85 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
25 |
15 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$782.21 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$253.48 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
12 |
$165.00 |