| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,819 |
2,778 |
$71K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,850 |
2,799 |
$60K |
| D1120 |
Prophylaxis - child |
1,127 |
1,114 |
$49K |
| D0274 |
Bitewings - four radiographic images |
1,689 |
1,656 |
$49K |
| D1110 |
Prophylaxis - adult |
1,505 |
1,474 |
$48K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,218 |
1,568 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
2,283 |
2,221 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
361 |
234 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
392 |
219 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
767 |
743 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
104 |
84 |
$4K |
| D0330 |
Panoramic radiographic image |
81 |
79 |
$2K |