| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,501 |
3,968 |
$169K |
| D0120 |
Periodic oral evaluation - established patient |
3,589 |
3,126 |
$100K |
| D1206 |
Topical application of fluoride varnish |
3,573 |
3,167 |
$84K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
625 |
336 |
$62K |
| D0274 |
Bitewings - four radiographic images |
887 |
828 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
1,055 |
993 |
$18K |
| D0330 |
Panoramic radiographic image |
228 |
214 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
684 |
595 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
979 |
890 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
126 |
78 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
180 |
166 |
$10K |
| D0272 |
Bitewings - two radiographic images |
284 |
185 |
$5K |
| D1999 |
|
669 |
271 |
$0.00 |