| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,291 |
2,214 |
$92K |
| D0120 |
Periodic oral evaluation - established patient |
2,041 |
1,965 |
$57K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,777 |
1,707 |
$46K |
| D0274 |
Bitewings - four radiographic images |
365 |
344 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
1,049 |
1,001 |
$6K |
| D1351 |
Sealant - per tooth |
80 |
29 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
910 |
852 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
22 |
12 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
19 |
12 |
$399.95 |
| D0272 |
Bitewings - two radiographic images |
39 |
39 |
$386.88 |