| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
513 |
459 |
$12K |
| D1120 |
Prophylaxis - child |
314 |
278 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
679 |
618 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
526 |
481 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
624 |
557 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
47 |
28 |
$4K |
| D0272 |
Bitewings - two radiographic images |
137 |
124 |
$3K |
| D1110 |
Prophylaxis - adult |
53 |
51 |
$3K |
| D0274 |
Bitewings - four radiographic images |
84 |
78 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
44 |
38 |
$1K |
| D1206 |
Topical application of fluoride varnish |
49 |
48 |
$674.73 |
| D0603 |
|
776 |
703 |
$0.00 |
| D9215 |
|
156 |
124 |
$0.00 |
| D0601 |
|
27 |
26 |
$0.00 |