| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
560 |
511 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
737 |
667 |
$19K |
| D0274 |
Bitewings - four radiographic images |
451 |
415 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
263 |
236 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
112 |
61 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
303 |
270 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
937 |
861 |
$5K |
| D1110 |
Prophylaxis - adult |
152 |
141 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
789 |
719 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
130 |
104 |
$3K |
| D9110 |
|
52 |
50 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
14 |
$1K |
| D0272 |
Bitewings - two radiographic images |
30 |
25 |
$282.00 |