| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,065 |
1,064 |
$64K |
| D1110 |
Prophylaxis - adult |
726 |
724 |
$60K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
838 |
834 |
$48K |
| D0274 |
Bitewings - four radiographic images |
1,771 |
1,767 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,790 |
2,621 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,691 |
1,686 |
$28K |
| D1120 |
Prophylaxis - child |
733 |
731 |
$27K |
| D0330 |
Panoramic radiographic image |
880 |
877 |
$24K |
| D9430 |
|
811 |
752 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,343 |
1,282 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
139 |
76 |
$9K |
| D0350 |
|
785 |
293 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
143 |
143 |
$7K |
| D1206 |
Topical application of fluoride varnish |
180 |
179 |
$3K |
| D4910 |
|
27 |
26 |
$2K |