| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0274 |
Bitewings - four radiographic images |
1,923 |
1,786 |
$57K |
| D1206 |
Topical application of fluoride varnish |
2,450 |
2,311 |
$51K |
| D1120 |
Prophylaxis - child |
1,105 |
1,052 |
$46K |
| D0330 |
Panoramic radiographic image |
1,330 |
1,005 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,170 |
989 |
$43K |
| D1110 |
Prophylaxis - adult |
1,284 |
1,188 |
$41K |
| D0120 |
Periodic oral evaluation - established patient |
1,541 |
1,461 |
$40K |
| D0140 |
Limited oral evaluation - problem focused |
356 |
323 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
60 |
39 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
289 |
251 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
102 |
100 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
24 |
15 |
$2K |