| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,064 |
1,041 |
$36K |
| D1120 |
Prophylaxis - child |
1,004 |
981 |
$27K |
| D9999 |
Unspecified adjunctive procedure, by report |
101 |
100 |
$13K |
| D1206 |
Topical application of fluoride varnish |
579 |
570 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
290 |
285 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
989 |
835 |
$8K |
| D1110 |
Prophylaxis - adult |
116 |
116 |
$6K |
| D0272 |
Bitewings - two radiographic images |
873 |
836 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
80 |
80 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$1K |
| D1320 |
|
133 |
133 |
$982.98 |
| D1310 |
|
66 |
65 |
$644.00 |
| D9110 |
|
12 |
12 |
$311.50 |
| D0601 |
|
54 |
53 |
$91.00 |
| D1999 |
|
17 |
17 |
$0.00 |