| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
5,483 |
1,733 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
309 |
304 |
$13K |
| D1120 |
Prophylaxis - child |
428 |
420 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
301 |
296 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
142 |
85 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
1,236 |
1,167 |
$7K |
| D0350 |
|
711 |
352 |
$6K |
| D1206 |
Topical application of fluoride varnish |
226 |
225 |
$5K |
| D0274 |
Bitewings - four radiographic images |
325 |
324 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
99 |
64 |
$4K |
| D0272 |
Bitewings - two radiographic images |
439 |
423 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
191 |
184 |
$2K |
| D1999 |
|
38 |
32 |
$0.00 |