| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
843 |
828 |
$21K |
| D1110 |
Prophylaxis - adult |
555 |
542 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
760 |
730 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
100 |
65 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
273 |
255 |
$9K |
| D1120 |
Prophylaxis - child |
331 |
329 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
772 |
430 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
203 |
202 |
$3K |
| D0274 |
Bitewings - four radiographic images |
101 |
100 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
41 |
24 |
$3K |
| D0330 |
Panoramic radiographic image |
37 |
36 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
38 |
25 |
$1K |
| D0272 |
Bitewings - two radiographic images |
25 |
25 |
$436.75 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13 |
13 |
$411.85 |
| D1206 |
Topical application of fluoride varnish |
15 |
15 |
$264.15 |