| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
809 |
720 |
$40K |
| D1206 |
Topical application of fluoride varnish |
823 |
737 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
423 |
376 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
990 |
856 |
$11K |
| D0274 |
Bitewings - four radiographic images |
440 |
364 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
977 |
751 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
178 |
127 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
112 |
100 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
23 |
14 |
$1K |
| D0350 |
|
665 |
375 |
$1K |
| D0272 |
Bitewings - two radiographic images |
50 |
50 |
$1K |
| D0999 |
Unspecified diagnostic procedure, by report |
30 |
30 |
$900.00 |
| D0603 |
|
198 |
177 |
$869.75 |
| D9999 |
Unspecified adjunctive procedure, by report |
30 |
30 |
$600.00 |
| D0602 |
|
15 |
12 |
$45.00 |