| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,658 |
4,528 |
$83K |
| D1110 |
Prophylaxis - adult |
2,297 |
2,222 |
$77K |
| D1120 |
Prophylaxis - child |
2,995 |
2,916 |
$74K |
| D1999 |
|
3,266 |
2,476 |
$51K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
556 |
310 |
$44K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,033 |
2,932 |
$42K |
| D0274 |
Bitewings - four radiographic images |
1,547 |
1,496 |
$33K |
| D0330 |
Panoramic radiographic image |
516 |
496 |
$21K |
| D0272 |
Bitewings - two radiographic images |
1,108 |
1,062 |
$18K |
| D2394 |
|
126 |
73 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
586 |
553 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
101 |
67 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
147 |
122 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
134 |
121 |
$1K |