| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
889 |
862 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
1,231 |
1,200 |
$34K |
| D0274 |
Bitewings - four radiographic images |
386 |
370 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
132 |
103 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
273 |
262 |
$6K |
| D1206 |
Topical application of fluoride varnish |
224 |
214 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
508 |
478 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
154 |
150 |
$3K |
| D1110 |
Prophylaxis - adult |
39 |
39 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
232 |
225 |
$1K |
| D0330 |
Panoramic radiographic image |
49 |
47 |
$1K |