| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,100 |
1,996 |
$57K |
| D1120 |
Prophylaxis - child |
1,230 |
1,180 |
$57K |
| D1206 |
Topical application of fluoride varnish |
2,088 |
2,027 |
$53K |
| D1110 |
Prophylaxis - adult |
790 |
773 |
$50K |
| D0274 |
Bitewings - four radiographic images |
691 |
669 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
306 |
261 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
30 |
14 |
$3K |
| D0330 |
Panoramic radiographic image |
29 |
29 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
28 |
28 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
30 |
28 |
$567.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
14 |
12 |
$180.00 |