| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
630 |
608 |
$16K |
| D1110 |
Prophylaxis - adult |
300 |
289 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
871 |
854 |
$12K |
| D0274 |
Bitewings - four radiographic images |
392 |
368 |
$11K |
| D1120 |
Prophylaxis - child |
272 |
269 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
168 |
167 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
72 |
72 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
28 |
28 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
276 |
267 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
291 |
212 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
25 |
12 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20 |
12 |
$1K |
| D0603 |
|
1,206 |
1,168 |
$0.01 |
| D0602 |
|
42 |
40 |
$0.00 |