| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
774 |
729 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
1,145 |
1,088 |
$19K |
| D1110 |
Prophylaxis - adult |
590 |
562 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,317 |
1,237 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
221 |
99 |
$16K |
| D0272 |
Bitewings - two radiographic images |
1,024 |
962 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
190 |
77 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
265 |
250 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
112 |
107 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$348.00 |