| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,711 |
1,580 |
$65K |
| D0120 |
Periodic oral evaluation - established patient |
1,656 |
1,515 |
$42K |
| D1206 |
Topical application of fluoride varnish |
967 |
876 |
$23K |
| D0274 |
Bitewings - four radiographic images |
465 |
410 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
238 |
238 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
597 |
537 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
67 |
50 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
51 |
33 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
476 |
434 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
51 |
43 |
$884.10 |
| D0272 |
Bitewings - two radiographic images |
89 |
80 |
$733.20 |
| D1110 |
Prophylaxis - adult |
16 |
14 |
$558.40 |