| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,305 |
2,975 |
$132K |
| D1351 |
Sealant - per tooth |
1,717 |
728 |
$112K |
| D0120 |
Periodic oral evaluation - established patient |
3,424 |
3,095 |
$93K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,821 |
2,508 |
$72K |
| D0274 |
Bitewings - four radiographic images |
1,620 |
1,529 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
3,093 |
2,923 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,874 |
2,709 |
$17K |
| D1110 |
Prophylaxis - adult |
509 |
492 |
$12K |
| D8670 |
Periodic orthodontic treatment visit |
85 |
79 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
425 |
413 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
131 |
93 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
391 |
379 |
$5K |
| D4341 |
|
25 |
13 |
$4K |
| D0272 |
Bitewings - two radiographic images |
383 |
368 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
66 |
55 |
$3K |
| D0330 |
Panoramic radiographic image |
197 |
189 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
28 |
28 |
$453.60 |
| D9310 |
|
25 |
25 |
$410.40 |
| D0601 |
|
281 |
281 |
$66.00 |
| D0602 |
|
186 |
185 |
$36.75 |