| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,866 |
1,846 |
$84K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,937 |
1,917 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
1,064 |
1,049 |
$28K |
| D9920 |
|
566 |
543 |
$14K |
| D0272 |
Bitewings - two radiographic images |
577 |
555 |
$6K |
| D0601 |
|
674 |
670 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
890 |
866 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
204 |
194 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
65 |
65 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
638 |
625 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
25 |
14 |
$1K |
| D0602 |
|
67 |
66 |
$570.00 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$480.00 |
| D0274 |
Bitewings - four radiographic images |
26 |
25 |
$288.00 |
| D1330 |
|
951 |
918 |
$0.00 |
| D1310 |
|
944 |
911 |
$0.00 |