| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
405 |
387 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
458 |
423 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
397 |
378 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
154 |
137 |
$10K |
| D1110 |
Prophylaxis - adult |
226 |
207 |
$9K |
| D0274 |
Bitewings - four radiographic images |
472 |
439 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
945 |
876 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
296 |
282 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
1,098 |
1,014 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
296 |
291 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
118 |
109 |
$5K |
| D9110 |
|
63 |
61 |
$3K |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$112.80 |