| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,719 |
1,638 |
$42K |
| D2394 |
|
268 |
154 |
$30K |
| D1110 |
Prophylaxis - adult |
916 |
843 |
$28K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
310 |
150 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
971 |
855 |
$26K |
| D1120 |
Prophylaxis - child |
512 |
487 |
$21K |
| D0274 |
Bitewings - four radiographic images |
374 |
350 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
349 |
324 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
544 |
487 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
93 |
79 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
40 |
24 |
$3K |
| D1206 |
Topical application of fluoride varnish |
104 |
101 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
46 |
39 |
$1K |