| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,779 |
1,726 |
$73K |
| D0120 |
Periodic oral evaluation - established patient |
1,707 |
1,654 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,382 |
1,337 |
$36K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
235 |
196 |
$15K |
| D0274 |
Bitewings - four radiographic images |
248 |
248 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
657 |
620 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
518 |
490 |
$2K |
| D1999 |
|
209 |
166 |
$0.00 |
| D0190 |
|
211 |
166 |
$0.00 |