| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
749 |
746 |
$54K |
| D1110 |
Prophylaxis - adult |
490 |
483 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
410 |
403 |
$27K |
| D1120 |
Prophylaxis - child |
586 |
582 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
585 |
580 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,018 |
605 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
198 |
190 |
$2K |
| D0272 |
Bitewings - two radiographic images |
176 |
176 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
40 |
40 |
$2K |
| D9110 |
|
29 |
29 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
21 |
14 |
$1K |