| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1208 |
Topical application of fluoride, excluding varnish |
979 |
948 |
$13K |
| D1120 |
Prophylaxis - child |
653 |
640 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
749 |
727 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
49 |
46 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
23 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
50 |
47 |
$470.00 |
| D0240 |
|
30 |
12 |
$288.00 |
| D0220 |
Intraoral - periapical first radiographic image |
27 |
26 |
$135.00 |