| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,199 |
3,087 |
$83K |
| D1120 |
Prophylaxis - child |
1,701 |
1,657 |
$72K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,650 |
1,602 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,887 |
753 |
$38K |
| D1110 |
Prophylaxis - adult |
1,218 |
1,171 |
$37K |
| D0274 |
Bitewings - four radiographic images |
914 |
876 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
909 |
858 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
90 |
41 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
107 |
38 |
$6K |
| D0330 |
Panoramic radiographic image |
71 |
70 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
93 |
91 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
19 |
19 |
$945.36 |
| D0272 |
Bitewings - two radiographic images |
18 |
17 |
$503.68 |