| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,044 |
2,464 |
$72K |
| D0140 |
Limited oral evaluation - problem focused |
1,455 |
1,222 |
$48K |
| D0120 |
Periodic oral evaluation - established patient |
1,800 |
1,612 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,779 |
2,287 |
$37K |
| D0330 |
Panoramic radiographic image |
904 |
809 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
829 |
526 |
$18K |
| D0272 |
Bitewings - two radiographic images |
1,230 |
992 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
512 |
421 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
41 |
31 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
18 |
13 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
13 |
12 |
$969.51 |
| D1206 |
Topical application of fluoride varnish |
14 |
13 |
$245.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
18 |
17 |
$241.45 |
| D1999 |
|
16 |
15 |
$0.00 |