| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,679 |
1,538 |
$26K |
| D1120 |
Prophylaxis - child |
1,067 |
979 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,926 |
1,784 |
$24K |
| D1110 |
Prophylaxis - adult |
758 |
708 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
248 |
132 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,830 |
1,048 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,192 |
1,093 |
$11K |
| D0274 |
Bitewings - four radiographic images |
423 |
389 |
$8K |
| D0272 |
Bitewings - two radiographic images |
346 |
312 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
204 |
201 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
34 |
28 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
12 |
$1K |