| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
899 |
883 |
$17K |
| D1120 |
Prophylaxis - child |
604 |
593 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,006 |
988 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
183 |
73 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
102 |
99 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
25 |
13 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
26 |
13 |
$1K |
| D1110 |
Prophylaxis - adult |
25 |
25 |
$896.58 |
| D0220 |
Intraoral - periapical first radiographic image |
82 |
75 |
$735.51 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$371.40 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$143.40 |
| D0602 |
|
17 |
17 |
$0.00 |