| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,157 |
1,122 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
1,503 |
1,466 |
$36K |
| D1206 |
Topical application of fluoride varnish |
711 |
700 |
$19K |
| D1120 |
Prophylaxis - child |
245 |
242 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
678 |
652 |
$11K |
| D0274 |
Bitewings - four radiographic images |
287 |
280 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
583 |
530 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
43 |
40 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
53 |
53 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17 |
12 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$449.00 |
| D1999 |
|
54 |
49 |
$0.00 |