| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,759 |
2,725 |
$86K |
| D1110 |
Prophylaxis - adult |
1,465 |
1,444 |
$84K |
| D1206 |
Topical application of fluoride varnish |
2,137 |
2,112 |
$54K |
| D1120 |
Prophylaxis - child |
1,268 |
1,257 |
$53K |
| D0274 |
Bitewings - four radiographic images |
455 |
443 |
$18K |
| D0272 |
Bitewings - two radiographic images |
319 |
314 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
46 |
25 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
129 |
129 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
24 |
24 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
24 |
24 |
$459.09 |