| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
417 |
372 |
$14K |
| D1110 |
Prophylaxis - adult |
280 |
252 |
$11K |
| D0274 |
Bitewings - four radiographic images |
232 |
212 |
$7K |
| D0330 |
Panoramic radiographic image |
140 |
124 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
268 |
243 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
266 |
89 |
$3K |
| D1206 |
Topical application of fluoride varnish |
142 |
125 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
33 |
17 |
$2K |
| D1120 |
Prophylaxis - child |
53 |
46 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
125 |
115 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
83 |
29 |
$459.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$268.68 |