| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,258 |
4,127 |
$175K |
| D0120 |
Periodic oral evaluation - established patient |
5,928 |
5,768 |
$165K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,609 |
3,492 |
$94K |
| D1110 |
Prophylaxis - adult |
1,630 |
1,579 |
$71K |
| D0274 |
Bitewings - four radiographic images |
1,535 |
1,487 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
389 |
351 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
4,047 |
3,874 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,198 |
3,059 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
476 |
442 |
$11K |
| D0272 |
Bitewings - two radiographic images |
961 |
914 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
493 |
471 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
31 |
25 |
$1K |