| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,000 |
1,978 |
$73K |
| D0120 |
Periodic oral evaluation - established patient |
1,828 |
1,808 |
$54K |
| D1110 |
Prophylaxis - adult |
907 |
886 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
801 |
780 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,769 |
1,746 |
$37K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
266 |
163 |
$29K |
| D0272 |
Bitewings - two radiographic images |
1,219 |
1,207 |
$27K |
| D0330 |
Panoramic radiographic image |
319 |
312 |
$22K |
| D1206 |
Topical application of fluoride varnish |
400 |
393 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
118 |
79 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
74 |
67 |
$1K |