| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,931 |
1,892 |
$53K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,715 |
1,933 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,052 |
2,010 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
2,127 |
2,078 |
$25K |
| D1120 |
Prophylaxis - child |
666 |
653 |
$24K |
| D1110 |
Prophylaxis - adult |
445 |
436 |
$23K |
| D0274 |
Bitewings - four radiographic images |
626 |
616 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
63 |
26 |
$6K |
| D0272 |
Bitewings - two radiographic images |
230 |
225 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
63 |
38 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$2K |
| D1330 |
|
94 |
93 |
$820.75 |
| D0603 |
|
2,499 |
2,476 |
$0.00 |
| D0190 |
|
1,135 |
1,042 |
$0.00 |
| D1999 |
|
1,139 |
1,047 |
$0.00 |