| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
9,647 |
9,562 |
$265K |
| D1110 |
Prophylaxis - adult |
5,326 |
5,263 |
$256K |
| D1120 |
Prophylaxis - child |
5,936 |
5,894 |
$206K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,117 |
7,057 |
$142K |
| D0272 |
Bitewings - two radiographic images |
5,495 |
5,415 |
$94K |
| D1351 |
Sealant - per tooth |
3,120 |
791 |
$88K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
761 |
499 |
$71K |
| D0210 |
Intraoral - complete series of radiographic images |
842 |
842 |
$53K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
860 |
838 |
$39K |
| D1206 |
Topical application of fluoride varnish |
1,610 |
1,600 |
$38K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,278 |
2,822 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
3,825 |
3,501 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
193 |
152 |
$13K |
| D0145 |
Oral evaluation for a patient under three years of age |
185 |
184 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
72 |
45 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
32 |
26 |
$4K |
| D2140 |
|
37 |
30 |
$2K |
| D1354 |
|
107 |
38 |
$2K |