| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
653 |
636 |
$18K |
| D1120 |
Prophylaxis - child |
428 |
415 |
$14K |
| D1110 |
Prophylaxis - adult |
263 |
258 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,001 |
692 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
630 |
612 |
$9K |
| D0272 |
Bitewings - two radiographic images |
390 |
378 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
756 |
726 |
$8K |
| D0274 |
Bitewings - four radiographic images |
245 |
239 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
28 |
15 |
$3K |
| D0330 |
Panoramic radiographic image |
14 |
13 |
$236.87 |
| D0602 |
|
267 |
261 |
$0.00 |
| D0601 |
|
256 |
252 |
$0.00 |
| D0603 |
|
159 |
159 |
$0.00 |