| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,907 |
1,903 |
$54K |
| D0145 |
Oral evaluation for a patient under three years of age |
384 |
380 |
$53K |
| D1120 |
Prophylaxis - child |
1,480 |
1,475 |
$53K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,133 |
2,124 |
$31K |
| D1110 |
Prophylaxis - adult |
471 |
467 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
83 |
50 |
$7K |
| D0272 |
Bitewings - two radiographic images |
155 |
154 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
40 |
39 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$149.46 |
| D0603 |
|
266 |
264 |
$0.04 |
| D0601 |
|
2,155 |
2,146 |
$0.03 |