| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,020 |
1,963 |
$60K |
| D1110 |
Prophylaxis - adult |
1,090 |
1,045 |
$55K |
| D1120 |
Prophylaxis - child |
1,132 |
1,107 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,480 |
1,446 |
$28K |
| D0272 |
Bitewings - two radiographic images |
969 |
932 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
61 |
40 |
$7K |
| D1206 |
Topical application of fluoride varnish |
122 |
119 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
33 |
29 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
13 |
$630.37 |