| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,839 |
2,427 |
$104K |
| D0274 |
Bitewings - four radiographic images |
3,022 |
2,825 |
$89K |
| D1110 |
Prophylaxis - adult |
2,478 |
2,327 |
$80K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,889 |
3,662 |
$73K |
| D0330 |
Panoramic radiographic image |
1,758 |
1,564 |
$70K |
| D1120 |
Prophylaxis - child |
1,320 |
1,255 |
$54K |
| D0140 |
Limited oral evaluation - problem focused |
1,823 |
1,684 |
$49K |
| D0120 |
Periodic oral evaluation - established patient |
1,472 |
1,384 |
$35K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
480 |
286 |
$35K |
| D1351 |
Sealant - per tooth |
678 |
140 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,697 |
1,568 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
313 |
303 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
283 |
156 |
$3K |
| D7250 |
|
19 |
12 |
$3K |