| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
434 |
418 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
213 |
110 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
424 |
407 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
393 |
380 |
$11K |
| D0274 |
Bitewings - four radiographic images |
140 |
134 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
70 |
37 |
$5K |
| D1110 |
Prophylaxis - adult |
150 |
143 |
$5K |
| D0330 |
Panoramic radiographic image |
19 |
19 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
18 |
18 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
57 |
54 |
$733.54 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$434.88 |
| D0230 |
Intraoral - periapical each additional radiographic image |
31 |
28 |
$342.38 |