| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
553 |
539 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
869 |
842 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
637 |
630 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
169 |
77 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
128 |
117 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
262 |
240 |
$5K |
| D0274 |
Bitewings - four radiographic images |
136 |
133 |
$3K |
| D1120 |
Prophylaxis - child |
51 |
50 |
$2K |
| D1206 |
Topical application of fluoride varnish |
71 |
70 |
$1K |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$316.14 |
| D1330 |
|
58 |
52 |
$0.00 |