| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,695 |
1,461 |
$77K |
| D0120 |
Periodic oral evaluation - established patient |
1,431 |
1,235 |
$43K |
| D1206 |
Topical application of fluoride varnish |
1,444 |
1,299 |
$35K |
| D0274 |
Bitewings - four radiographic images |
502 |
434 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
81 |
42 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
378 |
329 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
69 |
63 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
99 |
80 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
245 |
155 |
$2K |
| D0601 |
|
112 |
94 |
$0.00 |