| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,351 |
1,276 |
$37K |
| D1120 |
Prophylaxis - child |
897 |
832 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
805 |
738 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
129 |
92 |
$12K |
| D0272 |
Bitewings - two radiographic images |
425 |
390 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
492 |
464 |
$3K |
| D0330 |
Panoramic radiographic image |
95 |
95 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
53 |
38 |
$2K |
| D1110 |
Prophylaxis - adult |
53 |
53 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
29 |
12 |
$2K |
| D1351 |
Sealant - per tooth |
33 |
12 |
$1K |
| D0274 |
Bitewings - four radiographic images |
55 |
55 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
179 |
174 |
$991.91 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
38 |
36 |
$920.62 |
| D0210 |
Intraoral - complete series of radiographic images |
44 |
43 |
$448.93 |