| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,314 |
2,115 |
$48K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
520 |
234 |
$43K |
| D1110 |
Prophylaxis - adult |
1,637 |
1,482 |
$42K |
| D1120 |
Prophylaxis - child |
838 |
780 |
$33K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
623 |
234 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,184 |
1,085 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
1,474 |
1,259 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
472 |
428 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
164 |
73 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
109 |
97 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
421 |
221 |
$3K |
| D2394 |
|
21 |
15 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
56 |
52 |
$1K |