| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,210 |
5,088 |
$101K |
| D1110 |
Prophylaxis - adult |
2,223 |
2,174 |
$81K |
| D1206 |
Topical application of fluoride varnish |
4,390 |
4,288 |
$77K |
| D1120 |
Prophylaxis - child |
1,106 |
1,082 |
$36K |
| D0274 |
Bitewings - four radiographic images |
1,135 |
1,111 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
435 |
253 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
156 |
93 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
169 |
166 |
$2K |
| D0603 |
|
135 |
134 |
$640.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13 |
12 |
$543.30 |
| D0272 |
Bitewings - two radiographic images |
16 |
15 |
$329.31 |