| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,031 |
1,019 |
$24K |
| D1110 |
Prophylaxis - adult |
423 |
419 |
$15K |
| D1206 |
Topical application of fluoride varnish |
910 |
897 |
$13K |
| D1120 |
Prophylaxis - child |
203 |
196 |
$4K |
| D1999 |
|
671 |
591 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
65 |
65 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
92 |
88 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
37 |
24 |
$1K |
| D0274 |
Bitewings - four radiographic images |
105 |
104 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
14 |
12 |
$762.82 |
| D0272 |
Bitewings - two radiographic images |
46 |
46 |
$469.49 |
| D0220 |
Intraoral - periapical first radiographic image |
70 |
69 |
$451.24 |