| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,932 |
1,926 |
$38K |
| D1110 |
Prophylaxis - adult |
1,699 |
1,693 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,362 |
1,354 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
293 |
131 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
255 |
151 |
$10K |
| D0274 |
Bitewings - four radiographic images |
979 |
977 |
$8K |
| D1120 |
Prophylaxis - child |
286 |
286 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
692 |
674 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
208 |
207 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
921 |
898 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
100 |
99 |
$2K |
| D8670 |
Periodic orthodontic treatment visit |
38 |
36 |
$2K |
| D1206 |
Topical application of fluoride varnish |
156 |
155 |
$2K |
| D9920 |
|
46 |
41 |
$975.00 |
| D0601 |
|
137 |
136 |
$930.00 |
| D0210 |
Intraoral - complete series of radiographic images |
25 |
24 |
$672.00 |
| D9430 |
|
35 |
25 |
$245.00 |
| D1999 |
|
1,435 |
1,195 |
$0.00 |