| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,576 |
1,552 |
$79K |
| D1110 |
Prophylaxis - adult |
1,508 |
1,461 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
2,822 |
2,766 |
$71K |
| D1206 |
Topical application of fluoride varnish |
1,978 |
1,951 |
$52K |
| D0220 |
Intraoral - periapical first radiographic image |
1,933 |
1,858 |
$33K |
| D0274 |
Bitewings - four radiographic images |
999 |
967 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,711 |
1,597 |
$24K |
| D0272 |
Bitewings - two radiographic images |
559 |
548 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
115 |
114 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
25 |
17 |
$2K |