| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,085 |
1,058 |
$54K |
| D0120 |
Periodic oral evaluation - established patient |
1,187 |
1,154 |
$25K |
| D4341 |
|
98 |
38 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
719 |
629 |
$10K |
| D1330 |
|
452 |
441 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
215 |
207 |
$5K |
| D4910 |
|
25 |
25 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
23 |
13 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
14 |
12 |
$568.00 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$511.00 |