| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,140 |
1,129 |
$53K |
| D0120 |
Periodic oral evaluation - established patient |
1,064 |
1,055 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
149 |
144 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,515 |
1,499 |
$6K |
| D1110 |
Prophylaxis - adult |
128 |
125 |
$5K |
| D0240 |
|
917 |
685 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
21 |
14 |
$1K |
| D1330 |
|
1,508 |
1,492 |
$926.26 |
| D3120 |
|
365 |
190 |
$619.85 |
| D0230 |
Intraoral - periapical each additional radiographic image |
749 |
384 |
$467.17 |
| D0220 |
Intraoral - periapical first radiographic image |
529 |
522 |
$395.74 |
| D9999 |
Unspecified adjunctive procedure, by report |
14 |
14 |
$350.00 |
| D0272 |
Bitewings - two radiographic images |
183 |
179 |
$160.08 |
| D0274 |
Bitewings - four radiographic images |
51 |
51 |
$100.46 |
| D0601 |
|
33 |
33 |
$3.00 |
| D9986 |
|
46 |
44 |
$0.00 |