| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
922 |
822 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
1,112 |
990 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
218 |
98 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
174 |
128 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
248 |
195 |
$8K |
| D0274 |
Bitewings - four radiographic images |
204 |
178 |
$7K |
| D1206 |
Topical application of fluoride varnish |
376 |
354 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
216 |
180 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
44 |
26 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
68 |
58 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
116 |
103 |
$1K |
| D1120 |
Prophylaxis - child |
55 |
40 |
$1K |
| D0270 |
|
16 |
13 |
$276.67 |
| D0603 |
|
83 |
80 |
$0.00 |
| D1330 |
|
274 |
229 |
$0.00 |
| D0602 |
|
21 |
20 |
$0.00 |