| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
307 |
279 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
332 |
305 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
530 |
475 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
463 |
412 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
398 |
362 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
27 |
13 |
$3K |
| D0272 |
Bitewings - two radiographic images |
119 |
116 |
$3K |
| D1110 |
Prophylaxis - adult |
13 |
12 |
$658.56 |
| D0274 |
Bitewings - four radiographic images |
14 |
13 |
$415.32 |
| D0601 |
|
331 |
312 |
$0.00 |
| D0603 |
|
62 |
56 |
$0.00 |