| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,960 |
1,916 |
$50K |
| D1110 |
Prophylaxis - adult |
917 |
892 |
$35K |
| D1120 |
Prophylaxis - child |
1,129 |
1,111 |
$31K |
| D1206 |
Topical application of fluoride varnish |
1,889 |
1,852 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
1,545 |
1,481 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,882 |
1,192 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
250 |
237 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
90 |
67 |
$10K |
| D0274 |
Bitewings - four radiographic images |
262 |
256 |
$8K |
| D0272 |
Bitewings - two radiographic images |
289 |
279 |
$5K |
| D0330 |
Panoramic radiographic image |
64 |
57 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19 |
14 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
29 |
29 |
$962.26 |