| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,931 |
1,826 |
$34K |
| D1110 |
Prophylaxis - adult |
841 |
793 |
$30K |
| D1120 |
Prophylaxis - child |
1,048 |
999 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,461 |
1,386 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
135 |
68 |
$9K |
| D0272 |
Bitewings - two radiographic images |
392 |
367 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
77 |
39 |
$4K |
| D0330 |
Panoramic radiographic image |
39 |
39 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
73 |
72 |
$2K |
| D0274 |
Bitewings - four radiographic images |
67 |
66 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
16 |
13 |
$152.60 |