| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
844 |
805 |
$22K |
| D1120 |
Prophylaxis - child |
651 |
621 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,194 |
1,140 |
$16K |
| D1110 |
Prophylaxis - adult |
279 |
262 |
$13K |
| D0272 |
Bitewings - two radiographic images |
300 |
288 |
$6K |
| D0274 |
Bitewings - four radiographic images |
151 |
144 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
40 |
13 |
$3K |
| D1351 |
Sealant - per tooth |
155 |
17 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
44 |
42 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
87 |
84 |
$3K |
| D0603 |
|
1,268 |
1,212 |
$0.00 |