| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,103 |
941 |
$33K |
| D1120 |
Prophylaxis - child |
1,167 |
1,002 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,092 |
925 |
$13K |
| D0272 |
Bitewings - two radiographic images |
484 |
405 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
127 |
117 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
38 |
27 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
41 |
41 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
67 |
57 |
$764.26 |
| D0330 |
Panoramic radiographic image |
13 |
12 |
$445.26 |