| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
687 |
226 |
$7K |
| D1120 |
Prophylaxis - child |
118 |
112 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
232 |
218 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
116 |
110 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
263 |
242 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
40 |
13 |
$2K |
| D0274 |
Bitewings - four radiographic images |
13 |
13 |
$449.93 |
| D1206 |
Topical application of fluoride varnish |
20 |
19 |
$249.90 |
| D0603 |
|
295 |
284 |
$0.00 |