| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,519 |
1,336 |
$35K |
| D1110 |
Prophylaxis - adult |
608 |
569 |
$27K |
| D1120 |
Prophylaxis - child |
606 |
527 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,315 |
1,166 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,124 |
993 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,213 |
1,082 |
$12K |
| D0274 |
Bitewings - four radiographic images |
370 |
353 |
$11K |
| D0272 |
Bitewings - two radiographic images |
424 |
388 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
100 |
39 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
64 |
62 |
$141.28 |
| D0601 |
|
1,525 |
1,459 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
34 |
34 |
$0.00 |