| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,313 |
1,238 |
$51K |
| D0120 |
Periodic oral evaluation - established patient |
1,332 |
1,249 |
$35K |
| D1206 |
Topical application of fluoride varnish |
1,051 |
993 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
436 |
279 |
$22K |
| D0274 |
Bitewings - four radiographic images |
739 |
691 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
118 |
76 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
210 |
198 |
$4K |
| D1110 |
Prophylaxis - adult |
36 |
25 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
139 |
122 |
$705.60 |
| D1999 |
|
182 |
119 |
$0.00 |
| D1330 |
|
14 |
13 |
$0.00 |