| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,022 |
1,947 |
$80K |
| D0120 |
Periodic oral evaluation - established patient |
1,961 |
1,916 |
$52K |
| D1208 |
Topical application of fluoride, excluding varnish |
737 |
692 |
$19K |
| D9110 |
|
173 |
156 |
$9K |
| D1110 |
Prophylaxis - adult |
252 |
250 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,519 |
1,428 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
329 |
304 |
$7K |
| D1206 |
Topical application of fluoride varnish |
254 |
253 |
$6K |
| D0274 |
Bitewings - four radiographic images |
362 |
349 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,512 |
1,421 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
59 |
49 |
$5K |
| D0272 |
Bitewings - two radiographic images |
68 |
61 |
$639.20 |
| D0140 |
Limited oral evaluation - problem focused |
30 |
27 |
$469.65 |