| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0220 |
Intraoral - periapical first radiographic image |
1,830 |
1,761 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,295 |
1,275 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
983 |
969 |
$3K |
| D1120 |
Prophylaxis - child |
539 |
532 |
$3K |
| D0274 |
Bitewings - four radiographic images |
579 |
569 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,411 |
1,299 |
$2K |
| D1110 |
Prophylaxis - adult |
298 |
296 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
196 |
111 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
28 |
27 |
$131.00 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$15.00 |
| D0601 |
|
72 |
60 |
$0.00 |