| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
1,508 |
1,477 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
1,474 |
1,434 |
$35K |
| D1110 |
Prophylaxis - adult |
993 |
970 |
$34K |
| D1120 |
Prophylaxis - child |
760 |
748 |
$21K |
| D1999 |
|
1,725 |
1,623 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
478 |
469 |
$11K |
| D0274 |
Bitewings - four radiographic images |
485 |
468 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
242 |
242 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
63 |
13 |
$4K |
| D0272 |
Bitewings - two radiographic images |
74 |
68 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
38 |
38 |
$244.33 |