| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
720 |
689 |
$19K |
| D1120 |
Prophylaxis - child |
466 |
447 |
$15K |
| D1206 |
Topical application of fluoride varnish |
644 |
617 |
$9K |
| D1110 |
Prophylaxis - adult |
161 |
151 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
322 |
295 |
$4K |
| D0274 |
Bitewings - four radiographic images |
71 |
67 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
204 |
184 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
22 |
13 |
$2K |
| D0272 |
Bitewings - two radiographic images |
49 |
46 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
59 |
58 |
$821.73 |
| D0602 |
|
201 |
193 |
$0.00 |
| D0603 |
|
193 |
185 |
$0.00 |
| D0601 |
|
90 |
89 |
$0.00 |