| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,441 |
2,402 |
$63K |
| D1110 |
Prophylaxis - adult |
1,605 |
1,586 |
$62K |
| D1120 |
Prophylaxis - child |
1,390 |
1,377 |
$39K |
| D1206 |
Topical application of fluoride varnish |
2,133 |
2,093 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
632 |
619 |
$27K |
| D0274 |
Bitewings - four radiographic images |
834 |
817 |
$27K |
| D0330 |
Panoramic radiographic image |
418 |
406 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,284 |
1,251 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
171 |
107 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,029 |
943 |
$12K |
| D0272 |
Bitewings - two radiographic images |
357 |
354 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
39 |
24 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
107 |
107 |
$2K |