| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
1,843 |
1,811 |
$45K |
| D1120 |
Prophylaxis - child |
967 |
947 |
$41K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
313 |
141 |
$40K |
| D0120 |
Periodic oral evaluation - established patient |
1,108 |
1,088 |
$32K |
| D1110 |
Prophylaxis - adult |
449 |
441 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
454 |
443 |
$23K |
| D0330 |
Panoramic radiographic image |
405 |
392 |
$17K |
| D0274 |
Bitewings - four radiographic images |
749 |
733 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
50 |
31 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
151 |
140 |
$6K |
| D0272 |
Bitewings - two radiographic images |
391 |
384 |
$6K |
| D1330 |
|
763 |
748 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
487 |
473 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
372 |
366 |
$2K |