| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
152 |
151 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
214 |
208 |
$6K |
| D1110 |
Prophylaxis - adult |
89 |
89 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
166 |
164 |
$4K |
| D0274 |
Bitewings - four radiographic images |
129 |
125 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
367 |
354 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
82 |
77 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
76 |
75 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
305 |
296 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
90 |
82 |
$2K |
| D9110 |
|
27 |
26 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16 |
14 |
$1K |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$144.17 |