| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,182 |
1,179 |
$67K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,800 |
2,133 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
589 |
586 |
$35K |
| D1120 |
Prophylaxis - child |
963 |
959 |
$34K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
438 |
243 |
$29K |
| D1110 |
Prophylaxis - adult |
247 |
247 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,708 |
1,707 |
$21K |
| D0274 |
Bitewings - four radiographic images |
961 |
958 |
$20K |
| D0350 |
|
1,293 |
659 |
$14K |
| D9430 |
|
429 |
414 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
719 |
667 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
141 |
141 |
$7K |
| D4910 |
|
38 |
38 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
52 |
27 |
$3K |
| D0272 |
Bitewings - two radiographic images |
25 |
25 |
$264.00 |