| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,235 |
1,221 |
$23K |
| D1120 |
Prophylaxis - child |
489 |
482 |
$9K |
| D1110 |
Prophylaxis - adult |
443 |
442 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,003 |
995 |
$4K |
| D0274 |
Bitewings - four radiographic images |
433 |
433 |
$4K |
| D9995 |
|
133 |
133 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
152 |
149 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
874 |
874 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
44 |
38 |
$1K |
| D9310 |
|
84 |
83 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
90 |
90 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
138 |
138 |
$654.00 |
| D1206 |
Topical application of fluoride varnish |
26 |
26 |
$187.50 |
| D1330 |
|
486 |
461 |
$0.00 |