| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,240 |
1,204 |
$43K |
| D0120 |
Periodic oral evaluation - established patient |
1,980 |
1,901 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,288 |
1,230 |
$19K |
| D0274 |
Bitewings - four radiographic images |
765 |
728 |
$19K |
| D1120 |
Prophylaxis - child |
573 |
531 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16 |
12 |
$1K |
| D1206 |
Topical application of fluoride varnish |
51 |
46 |
$711.89 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
27 |
27 |
$588.50 |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$562.87 |
| D0601 |
|
37 |
36 |
$180.00 |