| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,846 |
2,835 |
$127K |
| D0120 |
Periodic oral evaluation - established patient |
2,836 |
2,816 |
$89K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,837 |
2,826 |
$80K |
| D0274 |
Bitewings - four radiographic images |
1,764 |
1,750 |
$75K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,258 |
1,968 |
$64K |
| D0220 |
Intraoral - periapical first radiographic image |
2,140 |
2,084 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
534 |
506 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
241 |
240 |
$14K |
| D0330 |
Panoramic radiographic image |
101 |
99 |
$8K |
| D1110 |
Prophylaxis - adult |
264 |
256 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
29 |
13 |
$3K |