| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0274 |
Bitewings - four radiographic images |
1,263 |
1,239 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
1,265 |
1,243 |
$33K |
| D1120 |
Prophylaxis - child |
704 |
695 |
$31K |
| D1110 |
Prophylaxis - adult |
819 |
793 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
300 |
145 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
918 |
907 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,720 |
1,343 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,500 |
1,438 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
334 |
319 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
230 |
131 |
$14K |
| D1206 |
Topical application of fluoride varnish |
135 |
133 |
$3K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$937.86 |
| D1999 |
|
14 |
12 |
$0.00 |