| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,379 |
2,240 |
$57K |
| D1110 |
Prophylaxis - adult |
1,558 |
1,437 |
$55K |
| D1206 |
Topical application of fluoride varnish |
2,051 |
1,928 |
$31K |
| D1120 |
Prophylaxis - child |
873 |
844 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
187 |
132 |
$17K |
| D0274 |
Bitewings - four radiographic images |
288 |
247 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
259 |
240 |
$3K |
| D0272 |
Bitewings - two radiographic images |
141 |
133 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
105 |
89 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
85 |
61 |
$724.16 |
| D1999 |
|
557 |
480 |
$0.00 |