| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,092 |
1,970 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,930 |
1,823 |
$29K |
| D1120 |
Prophylaxis - child |
946 |
894 |
$27K |
| D1110 |
Prophylaxis - adult |
494 |
470 |
$19K |
| D1999 |
|
910 |
822 |
$12K |
| D0272 |
Bitewings - two radiographic images |
385 |
366 |
$7K |
| D0330 |
Panoramic radiographic image |
72 |
68 |
$3K |
| D0274 |
Bitewings - four radiographic images |
137 |
133 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
21 |
13 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19 |
12 |
$1K |