| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
439 |
388 |
$5K |
| D1110 |
Prophylaxis - adult |
234 |
215 |
$5K |
| D1120 |
Prophylaxis - child |
308 |
267 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
113 |
57 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
678 |
574 |
$4K |
| D0274 |
Bitewings - four radiographic images |
273 |
244 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
313 |
286 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
802 |
496 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
54 |
35 |
$2K |
| D0272 |
Bitewings - two radiographic images |
208 |
178 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
127 |
114 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
93 |
87 |
$1K |
| D1206 |
Topical application of fluoride varnish |
24 |
15 |
$116.01 |
| D1999 |
|
234 |
212 |
$0.00 |