| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,604 |
3,544 |
$107K |
| D1110 |
Prophylaxis - adult |
1,663 |
1,633 |
$101K |
| D1120 |
Prophylaxis - child |
2,074 |
2,041 |
$92K |
| D1206 |
Topical application of fluoride varnish |
3,382 |
3,324 |
$84K |
| D0274 |
Bitewings - four radiographic images |
827 |
813 |
$19K |
| D1330 |
|
1,802 |
1,770 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
63 |
44 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
144 |
138 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
49 |
29 |
$5K |
| D0272 |
Bitewings - two radiographic images |
278 |
273 |
$4K |
| D0330 |
Panoramic radiographic image |
32 |
28 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
22 |
19 |
$997.86 |
| D0220 |
Intraoral - periapical first radiographic image |
61 |
57 |
$551.71 |