| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
1,279 |
1,264 |
$67K |
| D1206 |
Topical application of fluoride varnish |
3,094 |
3,070 |
$54K |
| D1110 |
Prophylaxis - adult |
1,433 |
1,423 |
$46K |
| D0120 |
Periodic oral evaluation - established patient |
2,223 |
2,216 |
$45K |
| D0350 |
|
1,283 |
1,246 |
$43K |
| D0274 |
Bitewings - four radiographic images |
1,523 |
1,520 |
$36K |
| D1120 |
Prophylaxis - child |
1,410 |
1,403 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
906 |
905 |
$28K |
| D1330 |
|
1,202 |
1,173 |
$16K |
| D0272 |
Bitewings - two radiographic images |
607 |
602 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
583 |
554 |
$12K |
| D1351 |
Sealant - per tooth |
639 |
155 |
$11K |
| D2140 |
|
142 |
54 |
$6K |
| D0180 |
|
50 |
49 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
31 |
16 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
69 |
69 |
$567.53 |
| D9985 |
|
34 |
31 |
$0.00 |
| D1999 |
|
340 |
289 |
$0.00 |