| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,818 |
2,750 |
$73K |
| D1110 |
Prophylaxis - adult |
815 |
800 |
$30K |
| D1206 |
Topical application of fluoride varnish |
1,820 |
1,758 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
1,548 |
1,485 |
$23K |
| D1120 |
Prophylaxis - child |
819 |
803 |
$22K |
| D0274 |
Bitewings - four radiographic images |
131 |
129 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
30 |
15 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
219 |
135 |
$3K |
| D0272 |
Bitewings - two radiographic images |
87 |
83 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13 |
13 |
$606.45 |
| D1999 |
|
635 |
583 |
$0.00 |