| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
495 |
486 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,210 |
929 |
$12K |
| D0274 |
Bitewings - four radiographic images |
481 |
481 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
737 |
718 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
179 |
174 |
$7K |
| D1120 |
Prophylaxis - child |
222 |
209 |
$6K |
| D4910 |
|
43 |
43 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
88 |
85 |
$3K |
| D4341 |
|
48 |
13 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
190 |
175 |
$2K |
| D9430 |
|
54 |
52 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
22 |
12 |
$1K |
| D1110 |
Prophylaxis - adult |
12 |
12 |
$988.00 |
| D1330 |
|
33 |
33 |
$0.00 |