| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,579 |
1,565 |
$44K |
| D1110 |
Prophylaxis - adult |
739 |
733 |
$38K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,409 |
1,641 |
$37K |
| D1120 |
Prophylaxis - child |
985 |
974 |
$34K |
| D0274 |
Bitewings - four radiographic images |
911 |
902 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,781 |
1,763 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
230 |
112 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,728 |
1,694 |
$21K |
| D0145 |
Oral evaluation for a patient under three years of age |
116 |
114 |
$15K |
| D0272 |
Bitewings - two radiographic images |
592 |
586 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
83 |
82 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$284.68 |
| D1206 |
Topical application of fluoride varnish |
17 |
16 |
$238.50 |
| D0603 |
|
1,790 |
1,773 |
$0.00 |
| D1330 |
|
13 |
13 |
$0.00 |
| D0601 |
|
275 |
271 |
$0.00 |