| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,946 |
1,884 |
$62K |
| D0120 |
Periodic oral evaluation - established patient |
2,626 |
2,529 |
$58K |
| D0274 |
Bitewings - four radiographic images |
1,787 |
1,728 |
$55K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
733 |
478 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,613 |
2,527 |
$47K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
559 |
344 |
$42K |
| D1110 |
Prophylaxis - adult |
686 |
661 |
$29K |
| D0272 |
Bitewings - two radiographic images |
530 |
511 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
106 |
100 |
$3K |
| D1999 |
|
49 |
49 |
$0.00 |