| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
273 |
228 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
350 |
291 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
241 |
202 |
$5K |
| D1110 |
Prophylaxis - adult |
99 |
82 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
166 |
129 |
$3K |
| D0274 |
Bitewings - four radiographic images |
195 |
165 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
120 |
89 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
49 |
30 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
77 |
37 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
319 |
267 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
82 |
63 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
258 |
212 |
$999.04 |
| D0272 |
Bitewings - two radiographic images |
19 |
18 |
$188.53 |