| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
3,378 |
3,228 |
$184K |
| D1120 |
Prophylaxis - child |
4,240 |
4,067 |
$144K |
| D1110 |
Prophylaxis - adult |
2,986 |
2,855 |
$140K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,378 |
928 |
$124K |
| D0120 |
Periodic oral evaluation - established patient |
4,505 |
4,267 |
$119K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,225 |
4,049 |
$82K |
| D0272 |
Bitewings - two radiographic images |
3,092 |
2,957 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,255 |
1,192 |
$55K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
451 |
333 |
$31K |
| D1206 |
Topical application of fluoride varnish |
1,106 |
1,067 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
427 |
364 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
38 |
38 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
147 |
128 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
12 |
$1K |