| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,888 |
2,775 |
$71K |
| D1120 |
Prophylaxis - child |
1,434 |
1,391 |
$60K |
| D1110 |
Prophylaxis - adult |
1,757 |
1,654 |
$52K |
| D0274 |
Bitewings - four radiographic images |
959 |
907 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
399 |
379 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
182 |
172 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
55 |
50 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
335 |
322 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
32 |
25 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
35 |
30 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
14 |
12 |
$716.84 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$361.60 |