| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,848 |
1,831 |
$105K |
| D1110 |
Prophylaxis - adult |
872 |
862 |
$73K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,150 |
2,136 |
$26K |
| D1120 |
Prophylaxis - child |
735 |
735 |
$24K |
| D9430 |
|
768 |
726 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
402 |
112 |
$22K |
| D0274 |
Bitewings - four radiographic images |
945 |
931 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,408 |
1,499 |
$14K |
| D0350 |
|
1,124 |
401 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
125 |
62 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
83 |
83 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
52 |
52 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
43 |
40 |
$491.80 |