| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,251 |
1,246 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,490 |
1,480 |
$24K |
| D1120 |
Prophylaxis - child |
793 |
789 |
$18K |
| D0272 |
Bitewings - two radiographic images |
874 |
869 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
69 |
39 |
$3K |
| D1351 |
Sealant - per tooth |
57 |
12 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
61 |
53 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17 |
12 |
$1K |