| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,172 |
2,124 |
$116K |
| D0120 |
Periodic oral evaluation - established patient |
2,292 |
2,250 |
$53K |
| D0274 |
Bitewings - four radiographic images |
854 |
833 |
$31K |
| D1206 |
Topical application of fluoride varnish |
632 |
629 |
$17K |
| D1120 |
Prophylaxis - child |
201 |
200 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
124 |
122 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
98 |
96 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
59 |
39 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
252 |
247 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
33 |
32 |
$2K |