| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,999 |
1,832 |
$68K |
| D1120 |
Prophylaxis - child |
2,181 |
1,916 |
$49K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
340 |
186 |
$36K |
| D0330 |
Panoramic radiographic image |
965 |
850 |
$31K |
| D1206 |
Topical application of fluoride varnish |
1,441 |
1,343 |
$29K |
| D1351 |
Sealant - per tooth |
1,090 |
212 |
$29K |
| D0272 |
Bitewings - two radiographic images |
1,263 |
1,108 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
155 |
155 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
256 |
222 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
100 |
67 |
$8K |
| D0274 |
Bitewings - four radiographic images |
229 |
212 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
245 |
228 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
14 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
188 |
171 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
70 |
56 |
$920.84 |
| D1110 |
Prophylaxis - adult |
15 |
12 |
$431.00 |