| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,165 |
1,003 |
$26K |
| D1110 |
Prophylaxis - adult |
701 |
640 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,245 |
1,051 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
940 |
613 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
90 |
52 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
589 |
510 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
176 |
156 |
$7K |
| D0330 |
Panoramic radiographic image |
108 |
94 |
$6K |
| D0274 |
Bitewings - four radiographic images |
161 |
141 |
$5K |
| D1120 |
Prophylaxis - child |
183 |
152 |
$4K |
| D1206 |
Topical application of fluoride varnish |
63 |
57 |
$956.46 |