| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
1,341 |
1,330 |
$34K |
| D1110 |
Prophylaxis - adult |
520 |
516 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
906 |
898 |
$27K |
| D0274 |
Bitewings - four radiographic images |
572 |
569 |
$13K |
| D1120 |
Prophylaxis - child |
271 |
271 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
86 |
55 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
99 |
92 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
85 |
82 |
$5K |
| D1330 |
|
345 |
345 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15 |
12 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
32 |
27 |
$1K |
| D3120 |
|
29 |
17 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
24 |
24 |
$283.68 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$180.00 |