| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
515 |
474 |
$7K |
| D1110 |
Prophylaxis - adult |
245 |
228 |
$6K |
| D1206 |
Topical application of fluoride varnish |
549 |
506 |
$5K |
| D1120 |
Prophylaxis - child |
198 |
174 |
$3K |
| D0274 |
Bitewings - four radiographic images |
233 |
212 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
445 |
396 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
101 |
85 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
111 |
105 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
340 |
251 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
143 |
121 |
$1K |
| D0330 |
Panoramic radiographic image |
76 |
71 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16 |
15 |
$783.62 |