| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,023 |
1,980 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
2,760 |
2,691 |
$61K |
| D1206 |
Topical application of fluoride varnish |
2,550 |
2,479 |
$45K |
| D1110 |
Prophylaxis - adult |
1,087 |
1,043 |
$43K |
| D0272 |
Bitewings - two radiographic images |
1,429 |
1,399 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
181 |
79 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
157 |
66 |
$12K |
| D0274 |
Bitewings - four radiographic images |
94 |
90 |
$3K |
| D0330 |
Panoramic radiographic image |
38 |
38 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
54 |
53 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
47 |
43 |
$525.60 |