| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
1,818 |
1,438 |
$156K |
| D1110 |
Prophylaxis - adult |
2,954 |
2,405 |
$139K |
| D0120 |
Periodic oral evaluation - established patient |
3,224 |
2,648 |
$76K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,822 |
1,482 |
$68K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,214 |
2,614 |
$67K |
| D1120 |
Prophylaxis - child |
2,140 |
1,759 |
$57K |
| D1351 |
Sealant - per tooth |
1,193 |
207 |
$44K |
| D0140 |
Limited oral evaluation - problem focused |
1,259 |
991 |
$41K |
| D0274 |
Bitewings - four radiographic images |
1,165 |
956 |
$33K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
286 |
150 |
$25K |
| D0330 |
Panoramic radiographic image |
136 |
91 |
$8K |
| D0272 |
Bitewings - two radiographic images |
539 |
449 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
27 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
110 |
75 |
$671.25 |
| D0230 |
Intraoral - periapical each additional radiographic image |
67 |
12 |
$478.00 |
| D1999 |
|
14 |
14 |
$0.00 |