| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
619 |
562 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
828 |
749 |
$22K |
| D1110 |
Prophylaxis - adult |
210 |
177 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
86 |
69 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
680 |
630 |
$4K |
| D1206 |
Topical application of fluoride varnish |
215 |
204 |
$4K |
| D0274 |
Bitewings - four radiographic images |
240 |
218 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
187 |
171 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
508 |
460 |
$2K |
| D0272 |
Bitewings - two radiographic images |
193 |
170 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
45 |
44 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
26 |
24 |
$388.80 |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
12 |
$79.30 |
| D0350 |
|
28 |
27 |
$0.00 |
| D1330 |
|
70 |
60 |
$0.00 |