| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,837 |
1,781 |
$46K |
| D1120 |
Prophylaxis - child |
804 |
773 |
$33K |
| D1110 |
Prophylaxis - adult |
836 |
790 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,088 |
1,016 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
277 |
173 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
593 |
551 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
571 |
548 |
$15K |
| D0274 |
Bitewings - four radiographic images |
689 |
669 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,383 |
1,325 |
$8K |
| D9110 |
|
171 |
115 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,063 |
1,019 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
127 |
124 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
27 |
17 |
$1K |
| D0272 |
Bitewings - two radiographic images |
15 |
15 |
$166.35 |