| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,201 |
1,085 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
1,320 |
1,190 |
$27K |
| D1206 |
Topical application of fluoride varnish |
1,517 |
1,378 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
306 |
122 |
$18K |
| D0272 |
Bitewings - two radiographic images |
992 |
897 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,497 |
1,332 |
$15K |
| D1110 |
Prophylaxis - adult |
340 |
304 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,248 |
1,116 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
205 |
193 |
$6K |
| D0274 |
Bitewings - four radiographic images |
268 |
243 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
48 |
26 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
144 |
132 |
$3K |
| D0330 |
Panoramic radiographic image |
53 |
51 |
$2K |
| D0240 |
|
159 |
128 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
124 |
113 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
36 |
31 |
$912.54 |