| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
965 |
955 |
$40K |
| D1110 |
Prophylaxis - adult |
306 |
303 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
946 |
939 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
341 |
173 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
101 |
101 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
154 |
88 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
226 |
225 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,359 |
1,341 |
$7K |
| D0274 |
Bitewings - four radiographic images |
988 |
980 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
1,377 |
1,334 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,271 |
1,199 |
$1K |
| D9999 |
Unspecified adjunctive procedure, by report |
27 |
27 |
$675.00 |
| D0140 |
Limited oral evaluation - problem focused |
25 |
25 |
$289.00 |