| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,114 |
1,093 |
$53K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
352 |
344 |
$26K |
| D1110 |
Prophylaxis - adult |
833 |
826 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
268 |
107 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
205 |
94 |
$14K |
| D1120 |
Prophylaxis - child |
481 |
466 |
$10K |
| D0274 |
Bitewings - four radiographic images |
855 |
842 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
374 |
279 |
$2K |
| D0330 |
Panoramic radiographic image |
287 |
281 |
$2K |
| D1330 |
|
1,222 |
1,197 |
$1K |
| D3120 |
|
316 |
114 |
$1K |
| D0272 |
Bitewings - two radiographic images |
292 |
284 |
$549.55 |
| D1208 |
Topical application of fluoride, excluding varnish |
1,338 |
1,312 |
$497.95 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,434 |
1,393 |
$473.01 |
| D0220 |
Intraoral - periapical first radiographic image |
1,536 |
1,503 |
$349.70 |
| D1999 |
|
431 |
429 |
$90.47 |