| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
743 |
728 |
$20K |
| D1120 |
Prophylaxis - child |
360 |
351 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
843 |
823 |
$12K |
| D1110 |
Prophylaxis - adult |
198 |
192 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
614 |
601 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
520 |
509 |
$6K |
| D0272 |
Bitewings - two radiographic images |
252 |
247 |
$6K |
| D0274 |
Bitewings - four radiographic images |
152 |
148 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
26 |
15 |
$2K |
| D0603 |
|
144 |
134 |
$0.00 |
| D0602 |
|
494 |
483 |
$0.00 |
| D0601 |
|
24 |
24 |
$0.00 |