| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,187 |
1,159 |
$39K |
| D0601 |
|
302 |
292 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
349 |
331 |
$14K |
| D0603 |
|
446 |
440 |
$12K |
| D0274 |
Bitewings - four radiographic images |
173 |
173 |
$5K |
| D1120 |
Prophylaxis - child |
1,023 |
1,007 |
$4K |
| D0272 |
Bitewings - two radiographic images |
152 |
150 |
$3K |
| D0999 |
Unspecified diagnostic procedure, by report |
27 |
26 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
120 |
120 |
$107.64 |
| D0602 |
|
28 |
28 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
672 |
667 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
28 |
26 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
14 |
13 |
$0.00 |