| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,951 |
2,939 |
$158K |
| D1110 |
Prophylaxis - adult |
1,445 |
1,444 |
$120K |
| D1120 |
Prophylaxis - child |
1,925 |
1,919 |
$70K |
| D0210 |
Intraoral - complete series of radiographic images |
1,058 |
1,056 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
617 |
616 |
$38K |
| D0274 |
Bitewings - four radiographic images |
1,130 |
1,125 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,430 |
906 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
548 |
548 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
604 |
599 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
53 |
42 |
$4K |
| D0330 |
Panoramic radiographic image |
20 |
20 |
$592.50 |