| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
2,278 |
538 |
$29K |
| D1110 |
Prophylaxis - adult |
793 |
784 |
$25K |
| D1120 |
Prophylaxis - child |
375 |
375 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
283 |
280 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
588 |
586 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
426 |
409 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
408 |
408 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
123 |
71 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
102 |
64 |
$5K |
| D0272 |
Bitewings - two radiographic images |
219 |
217 |
$5K |
| D0274 |
Bitewings - four radiographic images |
85 |
85 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
133 |
133 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
27 |
26 |
$1K |
| D1206 |
Topical application of fluoride varnish |
62 |
61 |
$871.16 |