| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,350 |
1,330 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
1,676 |
1,651 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,329 |
1,301 |
$31K |
| D1110 |
Prophylaxis - adult |
580 |
565 |
$30K |
| D9110 |
|
360 |
350 |
$22K |
| D0274 |
Bitewings - four radiographic images |
569 |
555 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
253 |
246 |
$11K |
| D1206 |
Topical application of fluoride varnish |
273 |
272 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
313 |
295 |
$5K |
| D2140 |
|
23 |
16 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16 |
13 |
$2K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$857.73 |