| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,419 |
3,336 |
$86K |
| D1110 |
Prophylaxis - adult |
1,545 |
1,512 |
$59K |
| D4355 |
|
651 |
636 |
$42K |
| D1120 |
Prophylaxis - child |
1,312 |
1,295 |
$36K |
| D1206 |
Topical application of fluoride varnish |
1,962 |
1,910 |
$32K |
| D0330 |
Panoramic radiographic image |
563 |
541 |
$32K |
| D0274 |
Bitewings - four radiographic images |
999 |
968 |
$31K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
212 |
169 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,348 |
1,294 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
369 |
356 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
909 |
895 |
$14K |
| D0272 |
Bitewings - two radiographic images |
719 |
709 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
897 |
688 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
245 |
240 |
$9K |