| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,730 |
1,715 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
1,649 |
1,635 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,142 |
1,138 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
779 |
766 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
182 |
154 |
$13K |
| D1110 |
Prophylaxis - adult |
301 |
300 |
$13K |
| D0274 |
Bitewings - four radiographic images |
749 |
741 |
$12K |
| D4341 |
|
50 |
29 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,855 |
1,794 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
450 |
439 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
256 |
244 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,460 |
1,424 |
$6K |
| D0272 |
Bitewings - two radiographic images |
254 |
250 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
14 |
$1K |
| D1206 |
Topical application of fluoride varnish |
33 |
33 |
$858.00 |
| D0270 |
|
143 |
140 |
$787.80 |
| D0330 |
Panoramic radiographic image |
32 |
32 |
$672.00 |
| D9310 |
|
33 |
33 |
$564.30 |