| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
1,025 |
739 |
$28K |
| D1120 |
Prophylaxis - child |
955 |
810 |
$21K |
| D1206 |
Topical application of fluoride varnish |
885 |
741 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
497 |
393 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
126 |
42 |
$10K |
| D0330 |
Panoramic radiographic image |
210 |
157 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
123 |
116 |
$3K |
| D0272 |
Bitewings - two radiographic images |
76 |
58 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
66 |
53 |
$656.64 |
| D1208 |
Topical application of fluoride, excluding varnish |
13 |
13 |
$126.96 |