| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,159 |
2,007 |
$50K |
| D1110 |
Prophylaxis - adult |
839 |
794 |
$29K |
| D1120 |
Prophylaxis - child |
998 |
940 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,125 |
1,056 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
634 |
570 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
90 |
52 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
88 |
63 |
$7K |
| D0272 |
Bitewings - two radiographic images |
326 |
313 |
$6K |
| D0274 |
Bitewings - four radiographic images |
183 |
175 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
427 |
300 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
126 |
115 |
$5K |
| D0330 |
Panoramic radiographic image |
91 |
83 |
$4K |
| D1206 |
Topical application of fluoride varnish |
235 |
224 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
41 |
39 |
$1K |