| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
641 |
635 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
678 |
671 |
$19K |
| D1206 |
Topical application of fluoride varnish |
1,168 |
1,158 |
$17K |
| D0145 |
Oral evaluation for a patient under three years of age |
85 |
84 |
$12K |
| D1110 |
Prophylaxis - adult |
209 |
209 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,017 |
492 |
$11K |
| D0274 |
Bitewings - four radiographic images |
274 |
268 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
206 |
204 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
558 |
550 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
71 |
71 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
48 |
27 |
$5K |
| D0272 |
Bitewings - two radiographic images |
147 |
146 |
$3K |
| D0601 |
|
578 |
569 |
$0.00 |
| D0603 |
|
533 |
531 |
$0.00 |
| D0602 |
|
20 |
20 |
$0.00 |