| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,330 |
2,181 |
$53K |
| D1120 |
Prophylaxis - child |
1,099 |
1,044 |
$47K |
| D1110 |
Prophylaxis - adult |
1,013 |
972 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,105 |
1,966 |
$31K |
| D0274 |
Bitewings - four radiographic images |
909 |
860 |
$22K |
| D0330 |
Panoramic radiographic image |
648 |
612 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
256 |
175 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,385 |
1,306 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,666 |
1,203 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
210 |
204 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
59 |
39 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
29 |
24 |
$2K |
| D0272 |
Bitewings - two radiographic images |
17 |
16 |
$276.64 |