| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
1,692 |
1,233 |
$50K |
| D1120 |
Prophylaxis - child |
1,009 |
864 |
$25K |
| D1206 |
Topical application of fluoride varnish |
763 |
594 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
245 |
230 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
77 |
27 |
$6K |
| D0272 |
Bitewings - two radiographic images |
159 |
118 |
$2K |
| D0274 |
Bitewings - four radiographic images |
70 |
39 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
24 |
24 |
$394.77 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$312.05 |