| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,223 |
1,204 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
1,849 |
1,821 |
$38K |
| D1110 |
Prophylaxis - adult |
564 |
558 |
$21K |
| D0274 |
Bitewings - four radiographic images |
476 |
469 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
692 |
688 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
112 |
110 |
$4K |
| D0272 |
Bitewings - two radiographic images |
134 |
131 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
35 |
12 |
$2K |
| D1206 |
Topical application of fluoride varnish |
26 |
25 |
$348.30 |
| D0601 |
|
44 |
44 |
$0.00 |