| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
197 |
184 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
108 |
104 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
41 |
25 |
$5K |
| D1120 |
Prophylaxis - child |
114 |
108 |
$4K |
| D1110 |
Prophylaxis - adult |
61 |
57 |
$3K |
| D1206 |
Topical application of fluoride varnish |
61 |
59 |
$2K |
| D0330 |
Panoramic radiographic image |
29 |
28 |
$2K |
| D0274 |
Bitewings - four radiographic images |
44 |
41 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13 |
12 |
$511.92 |
| D0272 |
Bitewings - two radiographic images |
15 |
12 |
$292.50 |
| D1330 |
|
26 |
26 |
$182.85 |