| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
372 |
369 |
$10K |
| D1110 |
Prophylaxis - adult |
212 |
209 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
69 |
48 |
$7K |
| D1120 |
Prophylaxis - child |
244 |
241 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
433 |
216 |
$5K |
| D1206 |
Topical application of fluoride varnish |
297 |
292 |
$5K |
| D0274 |
Bitewings - four radiographic images |
149 |
146 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
294 |
287 |
$4K |
| D0330 |
Panoramic radiographic image |
71 |
71 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
87 |
85 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
103 |
102 |
$4K |
| D0272 |
Bitewings - two radiographic images |
104 |
102 |
$2K |