| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,363 |
3,298 |
$70K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,428 |
816 |
$53K |
| D1110 |
Prophylaxis - adult |
2,682 |
2,634 |
$51K |
| D1120 |
Prophylaxis - child |
1,752 |
1,720 |
$27K |
| D1206 |
Topical application of fluoride varnish |
1,796 |
1,763 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,016 |
1,008 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
554 |
320 |
$18K |
| D0274 |
Bitewings - four radiographic images |
1,851 |
1,820 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
477 |
473 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,437 |
2,219 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
2,908 |
2,829 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
617 |
602 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
707 |
685 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
42 |
29 |
$2K |
| D0330 |
Panoramic radiographic image |
24 |
24 |
$435.00 |