| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
836 |
768 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
735 |
677 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
291 |
285 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
90 |
52 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
303 |
270 |
$8K |
| D0272 |
Bitewings - two radiographic images |
156 |
147 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
54 |
51 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
15 |
14 |
$209.55 |