| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,613 |
2,555 |
$126K |
| D0120 |
Periodic oral evaluation - established patient |
2,634 |
2,576 |
$59K |
| D0274 |
Bitewings - four radiographic images |
898 |
871 |
$33K |
| D0210 |
Intraoral - complete series of radiographic images |
316 |
301 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
351 |
342 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
715 |
691 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
289 |
278 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
436 |
424 |
$5K |
| D1120 |
Prophylaxis - child |
164 |
159 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
36 |
25 |
$3K |
| D0272 |
Bitewings - two radiographic images |
72 |
68 |
$1K |