| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,009 |
3,792 |
$70K |
| D1120 |
Prophylaxis - child |
2,618 |
2,482 |
$66K |
| D1110 |
Prophylaxis - adult |
1,736 |
1,647 |
$57K |
| D1999 |
|
2,747 |
2,516 |
$50K |
| D0330 |
Panoramic radiographic image |
903 |
852 |
$39K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,750 |
1,626 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
262 |
207 |
$21K |
| D0272 |
Bitewings - two radiographic images |
1,303 |
1,223 |
$21K |
| D0274 |
Bitewings - four radiographic images |
746 |
713 |
$16K |
| D1206 |
Topical application of fluoride varnish |
467 |
445 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
70 |
56 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
267 |
246 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
67 |
54 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
32 |
32 |
$943.95 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
20 |
12 |
$840.00 |