| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
743 |
736 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,740 |
1,903 |
$24K |
| D1120 |
Prophylaxis - child |
598 |
591 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,654 |
1,344 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,202 |
1,190 |
$14K |
| D2330 |
|
140 |
100 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
188 |
188 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
156 |
156 |
$7K |
| D0274 |
Bitewings - four radiographic images |
262 |
256 |
$6K |
| D1110 |
Prophylaxis - adult |
39 |
39 |
$3K |
| D4910 |
|
39 |
38 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
35 |
24 |
$2K |
| D9430 |
|
45 |
41 |
$1K |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$156.00 |