| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
1,586 |
1,113 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,438 |
1,094 |
$43K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
376 |
259 |
$35K |
| D1120 |
Prophylaxis - child |
1,447 |
1,124 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,486 |
1,146 |
$18K |
| D0272 |
Bitewings - two radiographic images |
644 |
497 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
704 |
551 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
253 |
186 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
81 |
75 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15 |
14 |
$1K |