| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,409 |
1,393 |
$45K |
| D1120 |
Prophylaxis - child |
631 |
614 |
$33K |
| D1206 |
Topical application of fluoride varnish |
1,531 |
1,504 |
$27K |
| D1110 |
Prophylaxis - adult |
287 |
279 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
71 |
41 |
$8K |
| D0274 |
Bitewings - four radiographic images |
164 |
160 |
$6K |
| D0272 |
Bitewings - two radiographic images |
104 |
102 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
59 |
50 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
63 |
60 |
$980.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13 |
13 |
$215.00 |