| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0272 |
Bitewings - two radiographic images |
1,768 |
1,625 |
$26K |
| D0330 |
Panoramic radiographic image |
766 |
658 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
2,035 |
1,824 |
$17K |
| D1110 |
Prophylaxis - adult |
371 |
345 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
544 |
475 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
709 |
638 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,061 |
1,728 |
$14K |
| D1120 |
Prophylaxis - child |
221 |
216 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
530 |
515 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
123 |
96 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
24 |
13 |
$872.66 |
| D0601 |
|
915 |
799 |
$117.32 |
| D0602 |
|
46 |
45 |
$0.00 |
| D0603 |
|
41 |
39 |
$0.00 |