| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,617 |
1,564 |
$41K |
| D1110 |
Prophylaxis - adult |
974 |
925 |
$35K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
342 |
166 |
$32K |
| D1120 |
Prophylaxis - child |
1,014 |
982 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,648 |
1,597 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,243 |
1,140 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
506 |
468 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,424 |
1,354 |
$20K |
| D0274 |
Bitewings - four radiographic images |
526 |
507 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
174 |
83 |
$13K |
| D0330 |
Panoramic radiographic image |
186 |
173 |
$9K |
| D0272 |
Bitewings - two radiographic images |
318 |
307 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
154 |
140 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
12 |
$3K |