| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,458 |
1,425 |
$26K |
| D1120 |
Prophylaxis - child |
920 |
886 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,376 |
1,339 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
312 |
145 |
$17K |
| D1110 |
Prophylaxis - adult |
105 |
105 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
35 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
39 |
39 |
$650.24 |
| D0220 |
Intraoral - periapical first radiographic image |
28 |
26 |
$238.08 |
| D0602 |
|
14 |
14 |
$0.00 |