| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,498 |
1,460 |
$47K |
| D1206 |
Topical application of fluoride varnish |
2,438 |
2,381 |
$45K |
| D1110 |
Prophylaxis - adult |
814 |
795 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
1,860 |
1,809 |
$33K |
| D9630 |
|
1,683 |
1,634 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
760 |
754 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,535 |
631 |
$16K |
| D0274 |
Bitewings - four radiographic images |
573 |
558 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,180 |
1,153 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
475 |
462 |
$11K |
| D0330 |
Panoramic radiographic image |
150 |
149 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
63 |
36 |
$6K |
| D0272 |
Bitewings - two radiographic images |
42 |
42 |
$628.75 |