| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1208 |
Topical application of fluoride, excluding varnish |
1,445 |
1,434 |
$24K |
| D1110 |
Prophylaxis - adult |
496 |
475 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,856 |
878 |
$15K |
| D9996 |
|
1,235 |
1,146 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
912 |
895 |
$14K |
| D0274 |
Bitewings - four radiographic images |
673 |
655 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
527 |
400 |
$12K |
| D1120 |
Prophylaxis - child |
451 |
450 |
$11K |
| D9994 |
|
1,370 |
1,282 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,056 |
923 |
$8K |
| D9992 |
|
1,262 |
1,178 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
90 |
42 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
78 |
30 |
$4K |
| D0330 |
Panoramic radiographic image |
34 |
16 |
$755.86 |
| D0140 |
Limited oral evaluation - problem focused |
23 |
14 |
$322.79 |