| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,202 |
1,196 |
$35K |
| D1110 |
Prophylaxis - adult |
490 |
486 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
459 |
457 |
$11K |
| D1120 |
Prophylaxis - child |
195 |
195 |
$9K |
| D1206 |
Topical application of fluoride varnish |
272 |
271 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
74 |
37 |
$5K |
| D0274 |
Bitewings - four radiographic images |
351 |
350 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
666 |
652 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
66 |
64 |
$3K |
| D1351 |
Sealant - per tooth |
98 |
13 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
337 |
333 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
25 |
25 |
$1K |
| D0272 |
Bitewings - two radiographic images |
47 |
47 |
$470.00 |
| D0140 |
Limited oral evaluation - problem focused |
25 |
24 |
$300.00 |