| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,375 |
3,343 |
$108K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,670 |
3,634 |
$70K |
| D1120 |
Prophylaxis - child |
1,817 |
1,795 |
$67K |
| D1110 |
Prophylaxis - adult |
701 |
693 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,435 |
2,779 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
3,452 |
3,388 |
$28K |
| D0272 |
Bitewings - two radiographic images |
508 |
501 |
$14K |
| D1351 |
Sealant - per tooth |
255 |
59 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
133 |
126 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
40 |
24 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
27 |
14 |
$3K |
| D2140 |
|
21 |
12 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
28 |
28 |
$2K |
| D0330 |
Panoramic radiographic image |
19 |
19 |
$675.00 |
| D9310 |
|
16 |
14 |
$294.00 |
| D1999 |
|
83 |
81 |
$0.00 |