| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
194,228 |
50,852 |
$7.56M |
| D1120 |
Prophylaxis - child |
146,334 |
47,977 |
$5.43M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
127,222 |
34,804 |
$4.65M |
| D1206 |
Topical application of fluoride varnish |
62,161 |
25,470 |
$2.18M |
| D1351 |
Sealant - per tooth |
31,875 |
9,968 |
$1.24M |
| D0190 |
|
17,261 |
5,267 |
$633K |
| D1208 |
Topical application of fluoride, excluding varnish |
20,069 |
6,480 |
$629K |
| D0272 |
Bitewings - two radiographic images |
19,900 |
10,063 |
$498K |
| D0220 |
Intraoral - periapical first radiographic image |
20,913 |
15,548 |
$347K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,225 |
1,565 |
$291K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,102 |
1,529 |
$275K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,663 |
13,854 |
$173K |
| D1110 |
Prophylaxis - adult |
3,026 |
1,622 |
$108K |
| D0274 |
Bitewings - four radiographic images |
3,997 |
3,131 |
$94K |
| D9995 |
|
3,907 |
3,902 |
$65K |
| D1354 |
|
2,464 |
1,290 |
$50K |
| D0160 |
|
3,907 |
3,902 |
$47K |
| D0602 |
|
2,122 |
2,120 |
$11K |
| D0603 |
|
802 |
802 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
204 |
203 |
$3K |
| D0601 |
|
346 |
345 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
146 |
144 |
$2K |
| D0330 |
Panoramic radiographic image |
24 |
24 |
$617.52 |
| D0270 |
|
18 |
18 |
$182.38 |
| D0191 |
|
317 |
317 |
$0.00 |