| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,967 |
2,560 |
$46K |
| D1110 |
Prophylaxis - adult |
1,491 |
1,264 |
$43K |
| D1120 |
Prophylaxis - child |
1,857 |
1,552 |
$41K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
580 |
230 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,855 |
1,517 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
116 |
86 |
$8K |
| D0274 |
Bitewings - four radiographic images |
255 |
229 |
$5K |
| D1206 |
Topical application of fluoride varnish |
320 |
274 |
$5K |
| D0272 |
Bitewings - two radiographic images |
260 |
255 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
160 |
74 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
204 |
82 |
$1K |