| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,230 |
5,063 |
$130K |
| D1110 |
Prophylaxis - adult |
2,913 |
2,820 |
$108K |
| D1120 |
Prophylaxis - child |
2,542 |
2,467 |
$68K |
| D0272 |
Bitewings - two radiographic images |
2,320 |
2,262 |
$42K |
| D1206 |
Topical application of fluoride varnish |
2,504 |
2,427 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
532 |
509 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
328 |
316 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
114 |
93 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
118 |
83 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
509 |
482 |
$7K |
| D0330 |
Panoramic radiographic image |
27 |
27 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
70 |
37 |
$699.89 |