| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,114 |
4,019 |
$102K |
| D1120 |
Prophylaxis - child |
1,922 |
1,906 |
$85K |
| D1110 |
Prophylaxis - adult |
2,257 |
2,180 |
$73K |
| D1206 |
Topical application of fluoride varnish |
1,680 |
1,643 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,024 |
1,001 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,115 |
1,104 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
958 |
924 |
$27K |
| D0272 |
Bitewings - two radiographic images |
1,218 |
1,190 |
$25K |
| D0330 |
Panoramic radiographic image |
210 |
194 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
189 |
169 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
628 |
602 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
40 |
26 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
32 |
24 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
13 |
12 |
$608.92 |