| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,830 |
5,310 |
$118K |
| D1120 |
Prophylaxis - child |
3,510 |
3,197 |
$111K |
| D1110 |
Prophylaxis - adult |
2,096 |
1,889 |
$72K |
| D0272 |
Bitewings - two radiographic images |
3,672 |
3,345 |
$58K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,424 |
3,134 |
$50K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,245 |
432 |
$47K |
| D0220 |
Intraoral - periapical first radiographic image |
2,489 |
2,224 |
$19K |
| D0330 |
Panoramic radiographic image |
371 |
342 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,437 |
1,260 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
86 |
25 |
$3K |
| D2330 |
|
25 |
13 |
$938.64 |