| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,093 |
1,081 |
$58K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,565 |
1,473 |
$34K |
| D0274 |
Bitewings - four radiographic images |
1,038 |
1,029 |
$22K |
| D1120 |
Prophylaxis - child |
592 |
591 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
215 |
150 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
167 |
102 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
84 |
83 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
584 |
583 |
$5K |
| D1110 |
Prophylaxis - adult |
30 |
30 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$624.00 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$156.00 |
| D0431 |
|
83 |
82 |
$0.00 |