| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,877 |
3,787 |
$90K |
| D1110 |
Prophylaxis - adult |
2,205 |
2,161 |
$90K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,738 |
3,647 |
$74K |
| D1120 |
Prophylaxis - child |
2,274 |
2,209 |
$73K |
| D0330 |
Panoramic radiographic image |
1,462 |
1,422 |
$49K |
| D0274 |
Bitewings - four radiographic images |
1,891 |
1,840 |
$46K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
696 |
424 |
$38K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
367 |
250 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
720 |
700 |
$19K |
| D0272 |
Bitewings - two radiographic images |
589 |
569 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
812 |
786 |
$9K |
| D9110 |
|
136 |
134 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$1K |
| D1206 |
Topical application of fluoride varnish |
58 |
57 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
114 |
53 |
$919.33 |