| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0220 |
Intraoral - periapical first radiographic image |
1,499 |
1,035 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
500 |
400 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,395 |
849 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
295 |
273 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
140 |
128 |
$5K |
| D1120 |
Prophylaxis - child |
131 |
122 |
$5K |
| D1110 |
Prophylaxis - adult |
190 |
177 |
$5K |
| D0272 |
Bitewings - two radiographic images |
256 |
233 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
23 |
12 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
35 |
34 |
$937.86 |