| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
500 |
481 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
781 |
750 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
900 |
860 |
$18K |
| D1110 |
Prophylaxis - adult |
525 |
493 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
287 |
222 |
$9K |
| D0274 |
Bitewings - four radiographic images |
291 |
283 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
180 |
166 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
108 |
62 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
202 |
185 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
29 |
26 |
$283.10 |
| D1310 |
|
746 |
720 |
$0.00 |
| D1330 |
|
755 |
724 |
$0.00 |
| D0603 |
|
640 |
617 |
$0.00 |
| D0601 |
|
36 |
36 |
$0.00 |