| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
1,124 |
734 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
786 |
770 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
437 |
434 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
309 |
307 |
$7K |
| D0272 |
Bitewings - two radiographic images |
368 |
364 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
77 |
42 |
$4K |
| D1110 |
Prophylaxis - adult |
64 |
64 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
39 |
38 |
$1K |
| D0330 |
Panoramic radiographic image |
13 |
12 |
$608.64 |