| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
710 |
689 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
483 |
468 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
982 |
960 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
347 |
300 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
526 |
517 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
87 |
42 |
$9K |
| D0274 |
Bitewings - four radiographic images |
312 |
300 |
$7K |
| D1120 |
Prophylaxis - child |
136 |
129 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
20 |
18 |
$177.30 |
| D1330 |
|
31 |
23 |
$138.00 |