| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,595 |
1,425 |
$35K |
| D1110 |
Prophylaxis - adult |
973 |
865 |
$33K |
| D1206 |
Topical application of fluoride varnish |
1,497 |
1,329 |
$22K |
| D0274 |
Bitewings - four radiographic images |
1,606 |
1,402 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
229 |
114 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
525 |
428 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
401 |
337 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
870 |
711 |
$5K |
| D1999 |
|
392 |
294 |
$5K |
| D0330 |
Panoramic radiographic image |
266 |
221 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
51 |
30 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
111 |
111 |
$1K |
| D1120 |
Prophylaxis - child |
55 |
51 |
$896.22 |
| D0230 |
Intraoral - periapical each additional radiographic image |
16 |
13 |
$22.08 |