| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,400 |
2,296 |
$134K |
| D0120 |
Periodic oral evaluation - established patient |
3,547 |
3,419 |
$90K |
| D1120 |
Prophylaxis - child |
1,338 |
1,290 |
$65K |
| D1206 |
Topical application of fluoride varnish |
1,240 |
1,232 |
$33K |
| D0272 |
Bitewings - two radiographic images |
794 |
735 |
$21K |
| D0274 |
Bitewings - four radiographic images |
485 |
474 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
629 |
575 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
367 |
329 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
33 |
24 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
69 |
64 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
26 |
26 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
18 |
13 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15 |
13 |
$1K |