| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
399 |
386 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
933 |
612 |
$8K |
| D1120 |
Prophylaxis - child |
236 |
218 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
56 |
53 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
681 |
646 |
$7K |
| D1110 |
Prophylaxis - adult |
143 |
137 |
$6K |
| D0274 |
Bitewings - four radiographic images |
211 |
201 |
$5K |
| D1206 |
Topical application of fluoride varnish |
416 |
391 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
125 |
105 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
203 |
194 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
22 |
12 |
$2K |
| D0330 |
Panoramic radiographic image |
58 |
54 |
$1K |
| D0272 |
Bitewings - two radiographic images |
55 |
47 |
$1K |
| D0603 |
|
224 |
214 |
$0.00 |
| D0601 |
|
251 |
228 |
$0.00 |
| D0602 |
|
25 |
25 |
$0.00 |