| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
967 |
913 |
$23K |
| D1110 |
Prophylaxis - adult |
647 |
601 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
439 |
417 |
$17K |
| D1120 |
Prophylaxis - child |
622 |
601 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,287 |
638 |
$14K |
| D0274 |
Bitewings - four radiographic images |
503 |
467 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
864 |
811 |
$12K |
| D0330 |
Panoramic radiographic image |
173 |
172 |
$10K |
| D1206 |
Topical application of fluoride varnish |
536 |
516 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
83 |
46 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
447 |
414 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
27 |
17 |
$2K |
| D0272 |
Bitewings - two radiographic images |
95 |
95 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
40 |
39 |
$1K |