| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
681 |
643 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
128 |
82 |
$15K |
| D1206 |
Topical application of fluoride varnish |
624 |
588 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
129 |
85 |
$11K |
| D0330 |
Panoramic radiographic image |
279 |
260 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
260 |
232 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
255 |
235 |
$10K |
| D0274 |
Bitewings - four radiographic images |
373 |
352 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
221 |
217 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
446 |
386 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19 |
13 |
$138.30 |