| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,901 |
1,833 |
$50K |
| D1110 |
Prophylaxis - adult |
771 |
736 |
$37K |
| D1120 |
Prophylaxis - child |
874 |
845 |
$29K |
| D0274 |
Bitewings - four radiographic images |
531 |
510 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,007 |
972 |
$14K |
| D0272 |
Bitewings - two radiographic images |
592 |
572 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
166 |
163 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
76 |
28 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
18 |
12 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
14 |
12 |
$384.99 |
| D0601 |
|
2,035 |
1,967 |
$0.00 |