| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,473 |
2,844 |
$79K |
| D0120 |
Periodic oral evaluation - established patient |
2,215 |
2,039 |
$53K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,000 |
2,485 |
$40K |
| D0272 |
Bitewings - two radiographic images |
2,060 |
1,590 |
$26K |
| D0330 |
Panoramic radiographic image |
780 |
597 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,024 |
628 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,264 |
1,065 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
552 |
443 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
30 |
14 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
102 |
86 |
$3K |
| D1206 |
Topical application of fluoride varnish |
39 |
37 |
$820.43 |
| D0210 |
Intraoral - complete series of radiographic images |
117 |
27 |
$784.79 |