| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
772 |
740 |
$33K |
| D1120 |
Prophylaxis - child |
656 |
630 |
$31K |
| D1206 |
Topical application of fluoride varnish |
933 |
897 |
$31K |
| D0330 |
Panoramic radiographic image |
222 |
216 |
$22K |
| D1110 |
Prophylaxis - adult |
235 |
227 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
87 |
72 |
$17K |
| D0272 |
Bitewings - two radiographic images |
463 |
449 |
$17K |
| D0274 |
Bitewings - four radiographic images |
323 |
314 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
161 |
155 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
101 |
67 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
243 |
242 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
75 |
74 |
$6K |
| D1351 |
Sealant - per tooth |
112 |
26 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15 |
13 |
$306.92 |
| D0270 |
|
13 |
13 |
$199.00 |