| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,172 |
1,123 |
$31K |
| D1110 |
Prophylaxis - adult |
487 |
466 |
$25K |
| D0274 |
Bitewings - four radiographic images |
693 |
654 |
$21K |
| D1120 |
Prophylaxis - child |
557 |
534 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,150 |
1,085 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,064 |
1,009 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
570 |
551 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
50 |
14 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
15 |
12 |
$423.84 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$280.56 |
| D0602 |
|
1,327 |
1,283 |
$0.00 |