| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,111 |
2,079 |
$58K |
| D1120 |
Prophylaxis - child |
1,435 |
1,410 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,167 |
2,134 |
$30K |
| D1110 |
Prophylaxis - adult |
563 |
559 |
$29K |
| D0145 |
Oral evaluation for a patient under three years of age |
205 |
204 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
329 |
144 |
$22K |
| D0272 |
Bitewings - two radiographic images |
755 |
744 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
178 |
83 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
38 |
37 |
$450.90 |
| D0601 |
|
1,903 |
1,883 |
$0.00 |
| D0602 |
|
120 |
119 |
$0.00 |
| D0603 |
|
66 |
62 |
$0.00 |