| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,317 |
1,251 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
1,521 |
1,438 |
$53K |
| D1206 |
Topical application of fluoride varnish |
199 |
168 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
251 |
237 |
$10K |
| D1120 |
Prophylaxis - child |
229 |
192 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
70 |
52 |
$7K |
| D0274 |
Bitewings - four radiographic images |
244 |
234 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
478 |
468 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
38 |
26 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
26 |
26 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
56 |
56 |
$978.65 |
| D0140 |
Limited oral evaluation - problem focused |
137 |
71 |
$756.00 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$200.20 |