| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
564 |
545 |
$15K |
| D1120 |
Prophylaxis - child |
385 |
368 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
833 |
799 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
859 |
831 |
$10K |
| D0274 |
Bitewings - four radiographic images |
279 |
267 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
780 |
754 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
35 |
14 |
$3K |
| D0272 |
Bitewings - two radiographic images |
134 |
132 |
$3K |
| D1110 |
Prophylaxis - adult |
56 |
55 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
13 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
40 |
36 |
$1K |
| D1330 |
|
14 |
13 |
$121.28 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$81.53 |
| D0603 |
|
622 |
603 |
$0.00 |
| D0602 |
|
57 |
57 |
$0.00 |