| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,125 |
2,101 |
$89K |
| D0120 |
Periodic oral evaluation - established patient |
1,988 |
1,968 |
$68K |
| D1206 |
Topical application of fluoride varnish |
2,270 |
2,243 |
$65K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
399 |
218 |
$49K |
| D0272 |
Bitewings - two radiographic images |
852 |
842 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
88 |
85 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
39 |
29 |
$4K |
| D1110 |
Prophylaxis - adult |
58 |
58 |
$3K |
| D0240 |
|
128 |
62 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
16 |
16 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
16 |
16 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
13 |
$559.00 |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$484.00 |