| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,279 |
1,226 |
$37K |
| D1110 |
Prophylaxis - adult |
1,160 |
1,107 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
646 |
630 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
253 |
244 |
$8K |
| D1206 |
Topical application of fluoride varnish |
811 |
780 |
$7K |
| D0330 |
Panoramic radiographic image |
114 |
112 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
48 |
29 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
1,373 |
1,308 |
$1K |
| D1120 |
Prophylaxis - child |
112 |
110 |
$1K |
| D0274 |
Bitewings - four radiographic images |
950 |
907 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,161 |
1,104 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
28 |
16 |
$882.02 |
| D0140 |
Limited oral evaluation - problem focused |
15 |
15 |
$144.70 |
| D1330 |
|
620 |
598 |
$140.00 |