| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,490 |
3,015 |
$80K |
| D1120 |
Prophylaxis - child |
2,029 |
1,771 |
$73K |
| D1110 |
Prophylaxis - adult |
1,415 |
1,211 |
$73K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,070 |
2,663 |
$59K |
| D0272 |
Bitewings - two radiographic images |
1,745 |
1,487 |
$40K |
| D0330 |
Panoramic radiographic image |
398 |
341 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
262 |
240 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
63 |
39 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
39 |
30 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
193 |
180 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
28 |
27 |
$838.50 |
| D1999 |
|
37 |
17 |
$0.00 |