| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,465 |
1,410 |
$35K |
| D1110 |
Prophylaxis - adult |
932 |
901 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
1,752 |
1,535 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,759 |
1,186 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
153 |
82 |
$15K |
| D0274 |
Bitewings - four radiographic images |
425 |
403 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
677 |
647 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
124 |
75 |
$10K |
| D4355 |
|
155 |
141 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
115 |
108 |
$5K |
| D1120 |
Prophylaxis - child |
115 |
109 |
$3K |
| D0330 |
Panoramic radiographic image |
51 |
42 |
$2K |
| D1999 |
|
12 |
12 |
$0.00 |