| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,585 |
2,445 |
$84K |
| D1110 |
Prophylaxis - adult |
1,606 |
1,538 |
$76K |
| D0120 |
Periodic oral evaluation - established patient |
3,729 |
3,553 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
377 |
359 |
$15K |
| D0330 |
Panoramic radiographic image |
69 |
62 |
$6K |
| D1330 |
|
523 |
375 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16 |
12 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,644 |
2,472 |
$937.84 |
| D0272 |
Bitewings - two radiographic images |
1,694 |
1,602 |
$773.48 |
| D0220 |
Intraoral - periapical first radiographic image |
1,978 |
1,840 |
$749.85 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,871 |
1,735 |
$304.56 |
| D0274 |
Bitewings - four radiographic images |
62 |
52 |
$145.74 |
| D1999 |
|
114 |
108 |
$46.08 |
| D0601 |
|
18 |
12 |
$0.00 |