| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,044 |
2,023 |
$61K |
| D1206 |
Topical application of fluoride varnish |
2,349 |
2,327 |
$59K |
| D1110 |
Prophylaxis - adult |
648 |
644 |
$41K |
| D1120 |
Prophylaxis - child |
818 |
813 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
358 |
298 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
126 |
38 |
$15K |
| D0330 |
Panoramic radiographic image |
161 |
160 |
$7K |
| D0274 |
Bitewings - four radiographic images |
225 |
225 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
242 |
237 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
90 |
89 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
41 |
12 |
$4K |
| D1330 |
|
606 |
600 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
217 |
180 |
$2K |
| D9910 |
|
209 |
191 |
$2K |
| D0460 |
|
163 |
152 |
$2K |