| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
660 |
610 |
$16K |
| D1120 |
Prophylaxis - child |
522 |
495 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
167 |
70 |
$14K |
| D0145 |
Oral evaluation for a patient under three years of age |
105 |
104 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
992 |
932 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,295 |
754 |
$12K |
| D1110 |
Prophylaxis - adult |
270 |
246 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
989 |
916 |
$10K |
| D0274 |
Bitewings - four radiographic images |
329 |
301 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
99 |
97 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
130 |
123 |
$3K |
| D1206 |
Topical application of fluoride varnish |
77 |
76 |
$984.90 |
| D0603 |
|
935 |
865 |
$0.02 |
| D1999 |
|
30 |
26 |
$0.00 |
| D0601 |
|
115 |
113 |
$0.00 |
| D0602 |
|
25 |
25 |
$0.00 |