| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,920 |
2,913 |
$82K |
| D1110 |
Prophylaxis - adult |
1,449 |
1,443 |
$53K |
| D1120 |
Prophylaxis - child |
1,324 |
1,323 |
$41K |
| D0274 |
Bitewings - four radiographic images |
2,048 |
2,040 |
$28K |
| D1206 |
Topical application of fluoride varnish |
929 |
929 |
$19K |
| D0330 |
Panoramic radiographic image |
478 |
477 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
3,186 |
3,129 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,762 |
2,731 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
131 |
68 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
326 |
324 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
106 |
106 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
27 |
27 |
$1K |
| D0272 |
Bitewings - two radiographic images |
149 |
148 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
26 |
26 |
$832.00 |
| D2950 |
|
14 |
12 |
$756.00 |
| D1330 |
|
499 |
462 |
$0.00 |