| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,418 |
1,383 |
$25K |
| D1120 |
Prophylaxis - child |
737 |
710 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,241 |
1,204 |
$18K |
| D1110 |
Prophylaxis - adult |
448 |
437 |
$15K |
| D1999 |
|
836 |
774 |
$11K |
| D0272 |
Bitewings - two radiographic images |
348 |
335 |
$6K |
| D0274 |
Bitewings - four radiographic images |
214 |
210 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
19 |
12 |
$1K |
| D0330 |
Panoramic radiographic image |
15 |
15 |
$686.00 |
| D1206 |
Topical application of fluoride varnish |
14 |
13 |
$195.00 |