| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
558 |
555 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,871 |
1,247 |
$24K |
| D0274 |
Bitewings - four radiographic images |
699 |
692 |
$14K |
| D1110 |
Prophylaxis - adult |
142 |
142 |
$11K |
| D1120 |
Prophylaxis - child |
245 |
241 |
$8K |
| D1320 |
|
351 |
346 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
372 |
365 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
295 |
259 |
$3K |
| D1206 |
Topical application of fluoride varnish |
198 |
198 |
$3K |
| D9430 |
|
105 |
95 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
26 |
26 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
27 |
12 |
$2K |
| D0350 |
|
157 |
54 |
$1K |
| D1999 |
|
37 |
32 |
$0.00 |