| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,826 |
1,792 |
$79K |
| D0120 |
Periodic oral evaluation - established patient |
2,422 |
2,379 |
$68K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
709 |
480 |
$58K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,202 |
2,166 |
$55K |
| D0274 |
Bitewings - four radiographic images |
1,227 |
1,208 |
$43K |
| D1110 |
Prophylaxis - adult |
719 |
700 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
84 |
79 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
21 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
122 |
69 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
29 |
26 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
42 |
42 |
$543.78 |