| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,349 |
1,303 |
$53K |
| D0120 |
Periodic oral evaluation - established patient |
1,583 |
1,523 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,238 |
1,198 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
262 |
223 |
$11K |
| D0274 |
Bitewings - four radiographic images |
375 |
362 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
83 |
66 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
137 |
134 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
288 |
276 |
$2K |
| D0272 |
Bitewings - two radiographic images |
117 |
107 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
31 |
29 |
$630.60 |
| D0230 |
Intraoral - periapical each additional radiographic image |
120 |
114 |
$614.28 |
| D1110 |
Prophylaxis - adult |
13 |
13 |
$533.00 |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$226.00 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$194.40 |