| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,974 |
3,967 |
$218K |
| D1120 |
Prophylaxis - child |
4,213 |
4,208 |
$164K |
| D0230 |
Intraoral - periapical each additional radiographic image |
24,100 |
4,481 |
$96K |
| D0274 |
Bitewings - four radiographic images |
3,213 |
3,207 |
$68K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,583 |
4,577 |
$51K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
492 |
271 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
255 |
255 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
667 |
655 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
125 |
79 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
85 |
59 |
$5K |
| D0330 |
Panoramic radiographic image |
103 |
103 |
$3K |
| D0272 |
Bitewings - two radiographic images |
218 |
218 |
$3K |