| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,434 |
1,426 |
$39K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
695 |
455 |
$30K |
| D1110 |
Prophylaxis - adult |
1,027 |
1,025 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
353 |
229 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
437 |
437 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
382 |
382 |
$11K |
| D0274 |
Bitewings - four radiographic images |
633 |
633 |
$6K |
| D1120 |
Prophylaxis - child |
239 |
239 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
77 |
53 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
371 |
352 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
155 |
154 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
53 |
51 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16 |
15 |
$54.00 |