| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,198 |
2,150 |
$60K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
772 |
298 |
$60K |
| D1120 |
Prophylaxis - child |
1,186 |
1,171 |
$42K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,845 |
1,796 |
$42K |
| D1110 |
Prophylaxis - adult |
697 |
690 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,351 |
2,322 |
$33K |
| D0272 |
Bitewings - two radiographic images |
1,053 |
1,036 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,979 |
1,941 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
151 |
146 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
70 |
37 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
26 |
26 |
$919.51 |
| D0602 |
|
2,398 |
2,369 |
$27.01 |
| D0603 |
|
56 |
55 |
$0.00 |