| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
450 |
435 |
$19K |
| D1110 |
Prophylaxis - adult |
245 |
234 |
$18K |
| D0274 |
Bitewings - four radiographic images |
320 |
311 |
$17K |
| D1206 |
Topical application of fluoride varnish |
346 |
336 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
83 |
52 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
388 |
371 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
192 |
124 |
$7K |
| D1120 |
Prophylaxis - child |
97 |
95 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
28 |
25 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
36 |
14 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
14 |
13 |
$422.50 |