| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,789 |
1,646 |
$70K |
| D0120 |
Periodic oral evaluation - established patient |
2,844 |
2,626 |
$53K |
| D1206 |
Topical application of fluoride varnish |
404 |
371 |
$8K |
| D1120 |
Prophylaxis - child |
363 |
322 |
$6K |
| D0274 |
Bitewings - four radiographic images |
196 |
181 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
438 |
403 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
28 |
12 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
19 |
12 |
$390.50 |
| D0220 |
Intraoral - periapical first radiographic image |
15 |
13 |
$126.73 |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$49.62 |