| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,752 |
2,343 |
$53K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
781 |
454 |
$44K |
| D1110 |
Prophylaxis - adult |
1,777 |
1,485 |
$43K |
| D1120 |
Prophylaxis - child |
621 |
573 |
$25K |
| D0274 |
Bitewings - four radiographic images |
821 |
712 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
680 |
574 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,328 |
890 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
148 |
119 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
67 |
37 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
86 |
78 |
$2K |
| D1206 |
Topical application of fluoride varnish |
36 |
30 |
$824.18 |
| D0230 |
Intraoral - periapical each additional radiographic image |
18 |
12 |
$106.08 |
| D1999 |
|
101 |
85 |
$0.00 |