| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
5,644 |
1,079 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
306 |
306 |
$20K |
| D1120 |
Prophylaxis - child |
458 |
458 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
301 |
301 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
767 |
767 |
$10K |
| D0272 |
Bitewings - two radiographic images |
708 |
708 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
56 |
24 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
41 |
41 |
$2K |
| D0350 |
|
79 |
25 |
$748.80 |
| D0220 |
Intraoral - periapical first radiographic image |
42 |
42 |
$492.00 |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$259.20 |