| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,509 |
2,377 |
$44K |
| D1110 |
Prophylaxis - adult |
1,215 |
1,153 |
$42K |
| D1120 |
Prophylaxis - child |
1,367 |
1,296 |
$36K |
| D0272 |
Bitewings - two radiographic images |
1,626 |
1,553 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,821 |
1,749 |
$26K |
| D0330 |
Panoramic radiographic image |
532 |
506 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
83 |
53 |
$5K |
| D2140 |
|
98 |
73 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
193 |
181 |
$4K |
| D0274 |
Bitewings - four radiographic images |
66 |
65 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
19 |
14 |
$1K |
| D1206 |
Topical application of fluoride varnish |
40 |
40 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
17 |
12 |
$113.00 |