| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0220 |
Intraoral - periapical first radiographic image |
3,694 |
2,836 |
$1.07M |
| D0140 |
Limited oral evaluation - problem focused |
475 |
423 |
$245K |
| D1206 |
Topical application of fluoride varnish |
2,049 |
1,812 |
$154K |
| D1120 |
Prophylaxis - child |
335 |
320 |
$149K |
| D0120 |
Periodic oral evaluation - established patient |
386 |
351 |
$125K |
| D1110 |
Prophylaxis - adult |
326 |
293 |
$66K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
217 |
188 |
$58K |
| D1351 |
Sealant - per tooth |
303 |
52 |
$33K |
| D0274 |
Bitewings - four radiographic images |
388 |
341 |
$13K |
| D0272 |
Bitewings - two radiographic images |
43 |
40 |
$10K |
| D0330 |
Panoramic radiographic image |
176 |
161 |
$8K |
| D8670 |
Periodic orthodontic treatment visit |
81 |
72 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,357 |
1,084 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17 |
14 |
$4K |
| D9310 |
|
158 |
146 |
$653.00 |
| D1330 |
|
72 |
63 |
$0.00 |
| D1310 |
|
53 |
44 |
$0.00 |
| D0603 |
|
18 |
18 |
$0.00 |