| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,347 |
2,300 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
2,265 |
2,218 |
$45K |
| D1206 |
Topical application of fluoride varnish |
1,129 |
1,104 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,242 |
1,221 |
$20K |
| D0272 |
Bitewings - two radiographic images |
1,407 |
1,375 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
121 |
119 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
406 |
403 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
24 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
134 |
131 |
$746.94 |