| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,906 |
2,797 |
$73K |
| D1110 |
Prophylaxis - adult |
1,353 |
1,308 |
$49K |
| D1120 |
Prophylaxis - child |
1,694 |
1,639 |
$45K |
| D1351 |
Sealant - per tooth |
918 |
254 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,336 |
1,296 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,260 |
1,179 |
$18K |
| D1206 |
Topical application of fluoride varnish |
1,123 |
1,074 |
$18K |
| D0274 |
Bitewings - four radiographic images |
546 |
527 |
$17K |
| D0330 |
Panoramic radiographic image |
235 |
219 |
$14K |
| D0272 |
Bitewings - two radiographic images |
721 |
696 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
302 |
277 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
710 |
543 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
67 |
49 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
114 |
107 |
$4K |
| D1999 |
|
19 |
17 |
$0.00 |