| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,207 |
1,180 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
1,344 |
1,306 |
$34K |
| D1206 |
Topical application of fluoride varnish |
1,277 |
1,243 |
$26K |
| D0272 |
Bitewings - two radiographic images |
435 |
429 |
$10K |
| D0274 |
Bitewings - four radiographic images |
272 |
266 |
$8K |
| D1110 |
Prophylaxis - adult |
164 |
157 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
400 |
391 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
34 |
24 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
34 |
24 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
161 |
160 |
$2K |
| D0601 |
|
525 |
506 |
$0.00 |
| D0603 |
|
58 |
58 |
$0.00 |