| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
278 |
272 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
658 |
638 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
713 |
697 |
$918.04 |
| D0220 |
Intraoral - periapical first radiographic image |
1,073 |
1,035 |
$832.13 |
| D1110 |
Prophylaxis - adult |
174 |
166 |
$606.45 |
| D0230 |
Intraoral - periapical each additional radiographic image |
855 |
805 |
$563.31 |
| D0140 |
Limited oral evaluation - problem focused |
167 |
154 |
$556.13 |
| D0272 |
Bitewings - two radiographic images |
153 |
149 |
$533.10 |
| D0274 |
Bitewings - four radiographic images |
221 |
212 |
$382.35 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
33 |
14 |
$72.67 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
17 |
15 |
$68.84 |
| D1999 |
|
271 |
238 |
$0.00 |
| D9996 |
|
22 |
21 |
$0.00 |
| D1330 |
|
827 |
782 |
$0.00 |