| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,242 |
1,126 |
$75K |
| D0210 |
Intraoral - complete series of radiographic images |
824 |
768 |
$66K |
| D0140 |
Limited oral evaluation - problem focused |
615 |
564 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
638 |
562 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
803 |
728 |
$29K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
112 |
68 |
$22K |
| D0274 |
Bitewings - four radiographic images |
391 |
355 |
$17K |
| D1206 |
Topical application of fluoride varnish |
577 |
513 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
569 |
518 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
109 |
87 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$398.76 |
| D1999 |
|
377 |
315 |
$0.00 |
| D0601 |
|
32 |
30 |
$0.00 |