| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,019 |
2,834 |
$117K |
| D0120 |
Periodic oral evaluation - established patient |
5,144 |
4,436 |
$112K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,855 |
3,354 |
$77K |
| D1110 |
Prophylaxis - adult |
2,426 |
1,840 |
$46K |
| D9920 |
|
1,045 |
889 |
$34K |
| D0140 |
Limited oral evaluation - problem focused |
315 |
254 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
101 |
85 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
29 |
14 |
$3K |
| D0272 |
Bitewings - two radiographic images |
91 |
85 |
$3K |
| D0274 |
Bitewings - four radiographic images |
18 |
13 |
$470.40 |