| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
946 |
866 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
1,080 |
981 |
$29K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
394 |
329 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
865 |
786 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
551 |
530 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
217 |
178 |
$10K |
| D0274 |
Bitewings - four radiographic images |
558 |
510 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
297 |
284 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,337 |
1,209 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
454 |
426 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,016 |
915 |
$4K |
| D4341 |
|
24 |
17 |
$3K |
| D0270 |
|
100 |
96 |
$548.80 |
| D1110 |
Prophylaxis - adult |
13 |
13 |
$533.00 |
| D0272 |
Bitewings - two radiographic images |
57 |
39 |
$479.40 |