| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1999 |
|
403 |
303 |
$7K |
| D1206 |
Topical application of fluoride varnish |
191 |
178 |
$4K |
| D1110 |
Prophylaxis - adult |
105 |
100 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
120 |
115 |
$2K |
| D0274 |
Bitewings - four radiographic images |
117 |
111 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
20 |
14 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
46 |
44 |
$1K |
| D1120 |
Prophylaxis - child |
39 |
38 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
15 |
12 |
$395.85 |
| D1208 |
Topical application of fluoride, excluding varnish |
26 |
25 |
$360.00 |