| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,468 |
1,442 |
$44K |
| D1120 |
Prophylaxis - child |
958 |
933 |
$41K |
| D1110 |
Prophylaxis - adult |
636 |
624 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
992 |
969 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
329 |
322 |
$17K |
| D0274 |
Bitewings - four radiographic images |
371 |
365 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
56 |
26 |
$7K |
| D0330 |
Panoramic radiographic image |
136 |
133 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
64 |
61 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
47 |
45 |
$2K |
| D8670 |
Periodic orthodontic treatment visit |
26 |
25 |
$2K |
| D1206 |
Topical application of fluoride varnish |
69 |
69 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
63 |
55 |
$634.34 |