| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,661 |
1,655 |
$90K |
| D1120 |
Prophylaxis - child |
1,376 |
1,374 |
$51K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,710 |
1,472 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,763 |
1,756 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
274 |
274 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
181 |
181 |
$11K |
| D0272 |
Bitewings - two radiographic images |
878 |
870 |
$10K |
| D1110 |
Prophylaxis - adult |
103 |
103 |
$9K |
| D0274 |
Bitewings - four radiographic images |
401 |
401 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
125 |
78 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
151 |
73 |
$8K |
| D0350 |
|
340 |
291 |
$5K |
| D1206 |
Topical application of fluoride varnish |
121 |
121 |
$930.00 |
| D9430 |
|
13 |
13 |
$416.00 |