| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1208 |
Topical application of fluoride, excluding varnish |
915 |
848 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
522 |
501 |
$14K |
| D1120 |
Prophylaxis - child |
519 |
478 |
$11K |
| D1110 |
Prophylaxis - adult |
200 |
189 |
$8K |
| D0274 |
Bitewings - four radiographic images |
327 |
303 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
498 |
446 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
18 |
12 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
28 |
25 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
370 |
339 |
$797.43 |
| D1999 |
|
35 |
32 |
$230.00 |