| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
581 |
527 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
622 |
559 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
535 |
482 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
117 |
78 |
$7K |
| D0274 |
Bitewings - four radiographic images |
364 |
311 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
207 |
187 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
727 |
638 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
88 |
58 |
$4K |
| D1110 |
Prophylaxis - adult |
68 |
59 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
586 |
511 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
130 |
114 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
30 |
26 |
$810.90 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$103.40 |