| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,879 |
2,448 |
$55K |
| D1120 |
Prophylaxis - child |
2,174 |
1,836 |
$54K |
| D1110 |
Prophylaxis - adult |
1,500 |
1,255 |
$48K |
| D1206 |
Topical application of fluoride varnish |
2,142 |
1,775 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,338 |
1,099 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,147 |
1,017 |
$17K |
| D0330 |
Panoramic radiographic image |
465 |
386 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
711 |
568 |
$13K |
| D0272 |
Bitewings - two radiographic images |
793 |
689 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
111 |
96 |
$5K |
| D2140 |
|
104 |
60 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
44 |
27 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
113 |
82 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
189 |
152 |
$2K |
| D1351 |
Sealant - per tooth |
95 |
27 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
22 |
16 |
$1K |