| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
915 |
898 |
$24K |
| D1110 |
Prophylaxis - adult |
497 |
481 |
$22K |
| D1120 |
Prophylaxis - child |
527 |
515 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
166 |
95 |
$16K |
| D0330 |
Panoramic radiographic image |
265 |
255 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
745 |
726 |
$14K |
| D0272 |
Bitewings - two radiographic images |
213 |
210 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
91 |
91 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
90 |
90 |
$1K |
| D1206 |
Topical application of fluoride varnish |
40 |
38 |
$931.54 |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
13 |
$782.21 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13 |
12 |
$529.44 |