| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
527 |
502 |
$14K |
| D0272 |
Bitewings - two radiographic images |
614 |
588 |
$13K |
| D1110 |
Prophylaxis - adult |
226 |
219 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
562 |
540 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
647 |
618 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
674 |
598 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
38 |
15 |
$4K |
| D1120 |
Prophylaxis - child |
75 |
73 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$423.84 |
| D0602 |
|
687 |
669 |
$0.00 |