| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,670 |
1,645 |
$72K |
| D0120 |
Periodic oral evaluation - established patient |
1,440 |
1,411 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,111 |
1,070 |
$29K |
| D1206 |
Topical application of fluoride varnish |
483 |
479 |
$13K |
| D0272 |
Bitewings - two radiographic images |
292 |
291 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
38 |
28 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
14 |
14 |
$891.80 |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$564.48 |