| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,878 |
2,590 |
$62K |
| D1206 |
Topical application of fluoride varnish |
3,066 |
2,765 |
$48K |
| D1120 |
Prophylaxis - child |
1,755 |
1,604 |
$36K |
| D1110 |
Prophylaxis - adult |
628 |
553 |
$20K |
| D0274 |
Bitewings - four radiographic images |
1,176 |
1,051 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
122 |
55 |
$6K |
| D1999 |
|
314 |
294 |
$4K |
| D9999 |
Unspecified adjunctive procedure, by report |
84 |
82 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
253 |
231 |
$2K |
| D0272 |
Bitewings - two radiographic images |
187 |
172 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
249 |
111 |
$568.38 |
| D9920 |
|
13 |
13 |
$362.04 |