| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,895 |
1,886 |
$54K |
| D0120 |
Periodic oral evaluation - established patient |
2,183 |
2,172 |
$44K |
| D1110 |
Prophylaxis - adult |
835 |
835 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
1,662 |
1,654 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,848 |
1,445 |
$20K |
| D0274 |
Bitewings - four radiographic images |
663 |
663 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
662 |
662 |
$9K |
| D1206 |
Topical application of fluoride varnish |
491 |
491 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
52 |
38 |
$5K |
| D0330 |
Panoramic radiographic image |
86 |
86 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
85 |
85 |
$2K |
| D0602 |
|
234 |
234 |
$2K |
| D0272 |
Bitewings - two radiographic images |
80 |
80 |
$1K |
| D9110 |
|
17 |
15 |
$1K |
| D0603 |
|
45 |
45 |
$402.60 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$338.40 |
| D0601 |
|
17 |
17 |
$155.55 |