| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
454 |
448 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
300 |
296 |
$22K |
| D9999 |
Unspecified adjunctive procedure, by report |
157 |
113 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
91 |
79 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
81 |
79 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
32 |
32 |
$2K |
| D1206 |
Topical application of fluoride varnish |
88 |
88 |
$0.07 |
| D0274 |
Bitewings - four radiographic images |
15 |
13 |
$0.02 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$0.00 |