| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,190 |
1,185 |
$62K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,919 |
1,744 |
$28K |
| D1120 |
Prophylaxis - child |
777 |
770 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,631 |
1,621 |
$19K |
| D0274 |
Bitewings - four radiographic images |
556 |
552 |
$11K |
| D1110 |
Prophylaxis - adult |
96 |
96 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
114 |
106 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
120 |
119 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
354 |
285 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
36 |
24 |
$2K |
| D1999 |
|
18 |
18 |
$0.00 |