| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,165 |
1,069 |
$46K |
| D0120 |
Periodic oral evaluation - established patient |
1,708 |
1,470 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,839 |
1,618 |
$38K |
| D0274 |
Bitewings - four radiographic images |
779 |
685 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
301 |
159 |
$22K |
| D1110 |
Prophylaxis - adult |
791 |
651 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,007 |
573 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
217 |
194 |
$9K |
| D0330 |
Panoramic radiographic image |
123 |
110 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
40 |
25 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
60 |
53 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$519.14 |