| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
873 |
851 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
1,067 |
1,031 |
$22K |
| D1110 |
Prophylaxis - adult |
531 |
512 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
985 |
956 |
$16K |
| D0272 |
Bitewings - two radiographic images |
422 |
409 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
599 |
563 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
88 |
60 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
450 |
424 |
$4K |
| D1206 |
Topical application of fluoride varnish |
189 |
185 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
41 |
40 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
24 |
16 |
$1K |