| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,577 |
7,548 |
$457K |
| D1120 |
Prophylaxis - child |
7,337 |
7,308 |
$282K |
| D1110 |
Prophylaxis - adult |
2,509 |
2,502 |
$213K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,465 |
1,787 |
$165K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,545 |
2,543 |
$154K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,796 |
1,778 |
$151K |
| D1351 |
Sealant - per tooth |
3,562 |
948 |
$107K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,989 |
6,959 |
$92K |
| D0210 |
Intraoral - complete series of radiographic images |
1,597 |
1,595 |
$73K |
| D0274 |
Bitewings - four radiographic images |
3,168 |
3,152 |
$67K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,606 |
6,253 |
$66K |
| D9430 |
|
1,047 |
1,019 |
$33K |
| D4910 |
|
428 |
428 |
$33K |
| D1310 |
|
744 |
733 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
2,495 |
2,466 |
$29K |
| D2330 |
|
331 |
199 |
$26K |
| D0145 |
Oral evaluation for a patient under three years of age |
134 |
134 |
$9K |
| D0350 |
|
337 |
319 |
$6K |
| D0272 |
Bitewings - two radiographic images |
274 |
274 |
$3K |
| D1206 |
Topical application of fluoride varnish |
98 |
98 |
$2K |
| D0601 |
|
66 |
66 |
$915.00 |
| D0602 |
|
50 |
50 |
$675.00 |
| D0603 |
|
42 |
42 |
$570.00 |