| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
3,574 |
1,263 |
$38K |
| D0120 |
Periodic oral evaluation - established patient |
1,222 |
1,174 |
$33K |
| D1120 |
Prophylaxis - child |
884 |
843 |
$30K |
| D1110 |
Prophylaxis - adult |
411 |
400 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,504 |
1,439 |
$21K |
| D0274 |
Bitewings - four radiographic images |
626 |
607 |
$21K |
| D0145 |
Oral evaluation for a patient under three years of age |
120 |
118 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,380 |
1,311 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
156 |
72 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
53 |
47 |
$2K |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$303.94 |
| D0603 |
|
808 |
791 |
$0.00 |
| D0602 |
|
565 |
556 |
$0.00 |
| D0601 |
|
25 |
25 |
$0.00 |