| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,468 |
1,259 |
$54K |
| D0120 |
Periodic oral evaluation - established patient |
1,320 |
1,141 |
$22K |
| D9920 |
|
483 |
305 |
$10K |
| D1206 |
Topical application of fluoride varnish |
843 |
663 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
238 |
200 |
$3K |
| D0274 |
Bitewings - four radiographic images |
96 |
82 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
33 |
24 |
$1K |
| D1120 |
Prophylaxis - child |
34 |
28 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
21 |
12 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
89 |
73 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
34 |
26 |
$940.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
18 |
12 |
$232.00 |
| D1999 |
|
357 |
273 |
$0.00 |