| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1999 |
|
1,148 |
856 |
$20K |
| D1110 |
Prophylaxis - adult |
297 |
275 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
447 |
414 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
108 |
61 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
580 |
469 |
$5K |
| D1206 |
Topical application of fluoride varnish |
185 |
171 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
288 |
170 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
125 |
111 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
52 |
43 |
$1K |
| D0274 |
Bitewings - four radiographic images |
51 |
48 |
$982.80 |