| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
794 |
770 |
$21K |
| D1120 |
Prophylaxis - child |
322 |
316 |
$14K |
| D1110 |
Prophylaxis - adult |
462 |
432 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
82 |
70 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
37 |
25 |
$3K |
| D0274 |
Bitewings - four radiographic images |
92 |
85 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
55 |
55 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
46 |
40 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
26 |
26 |
$643.20 |
| D0220 |
Intraoral - periapical first radiographic image |
29 |
29 |
$294.12 |
| D1999 |
|
42 |
39 |
$0.00 |