| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,363 |
1,359 |
$60K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
961 |
958 |
$59K |
| D1120 |
Prophylaxis - child |
1,349 |
1,343 |
$42K |
| D0274 |
Bitewings - four radiographic images |
1,309 |
1,304 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
459 |
459 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,179 |
2,011 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,221 |
1,215 |
$11K |
| D9430 |
|
362 |
361 |
$11K |
| D1110 |
Prophylaxis - adult |
95 |
94 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
338 |
337 |
$4K |
| D0350 |
|
358 |
199 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
61 |
42 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
34 |
25 |
$2K |
| D1206 |
Topical application of fluoride varnish |
52 |
52 |
$538.00 |
| D0272 |
Bitewings - two radiographic images |
37 |
37 |
$444.00 |
| D1999 |
|
575 |
559 |
$138.00 |