| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,183 |
2,092 |
$71K |
| D0120 |
Periodic oral evaluation - established patient |
1,916 |
1,819 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,955 |
1,858 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
2,665 |
2,536 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,507 |
2,331 |
$22K |
| D0272 |
Bitewings - two radiographic images |
1,320 |
1,260 |
$22K |
| D1206 |
Topical application of fluoride varnish |
815 |
793 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
187 |
78 |
$13K |
| D0274 |
Bitewings - four radiographic images |
442 |
411 |
$11K |
| D1110 |
Prophylaxis - adult |
254 |
240 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
191 |
190 |
$7K |
| D0330 |
Panoramic radiographic image |
174 |
161 |
$7K |
| D0601 |
|
893 |
835 |
$0.00 |
| D0602 |
|
733 |
699 |
$0.00 |
| D0603 |
|
291 |
279 |
$0.00 |