| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,353 |
1,279 |
$36K |
| D1120 |
Prophylaxis - child |
426 |
392 |
$16K |
| D1110 |
Prophylaxis - adult |
347 |
336 |
$13K |
| D0274 |
Bitewings - four radiographic images |
513 |
482 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
126 |
95 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
331 |
317 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
64 |
56 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
26 |
26 |
$383.38 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$252.60 |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$171.60 |