| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
769 |
758 |
$22K |
| D1110 |
Prophylaxis - adult |
354 |
350 |
$19K |
| D1120 |
Prophylaxis - child |
431 |
425 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
135 |
62 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
653 |
646 |
$9K |
| D0274 |
Bitewings - four radiographic images |
216 |
211 |
$6K |
| D0272 |
Bitewings - two radiographic images |
204 |
202 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
16 |
16 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
120 |
118 |
$1K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$385.62 |
| D0602 |
|
235 |
231 |
$0.00 |
| D0603 |
|
395 |
390 |
$0.00 |
| D0601 |
|
218 |
218 |
$0.00 |