| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,026 |
1,016 |
$29K |
| D1110 |
Prophylaxis - adult |
496 |
493 |
$25K |
| D1206 |
Topical application of fluoride varnish |
958 |
949 |
$22K |
| D1120 |
Prophylaxis - child |
383 |
383 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
90 |
43 |
$8K |
| D0274 |
Bitewings - four radiographic images |
170 |
168 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
25 |
18 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
27 |
27 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
13 |
$222.95 |