| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
493 |
434 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
551 |
497 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
150 |
131 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
472 |
425 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
30 |
27 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
465 |
418 |
$2K |
| D0272 |
Bitewings - two radiographic images |
196 |
184 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17 |
14 |
$1K |
| D0274 |
Bitewings - four radiographic images |
44 |
39 |
$726.70 |
| D2140 |
|
14 |
12 |
$647.85 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
30 |
28 |
$631.50 |