| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0220 |
Intraoral - periapical first radiographic image |
1,582 |
1,421 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
390 |
332 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
455 |
431 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
436 |
421 |
$1K |
| D1120 |
Prophylaxis - child |
146 |
140 |
$838.55 |
| D1110 |
Prophylaxis - adult |
205 |
191 |
$737.82 |
| D0230 |
Intraoral - periapical each additional radiographic image |
624 |
545 |
$699.88 |
| D0274 |
Bitewings - four radiographic images |
251 |
234 |
$609.59 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
74 |
25 |
$451.22 |
| D0330 |
Panoramic radiographic image |
57 |
54 |
$435.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
46 |
43 |
$122.40 |