| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,595 |
1,444 |
$41K |
| D1110 |
Prophylaxis - adult |
982 |
873 |
$35K |
| D1120 |
Prophylaxis - child |
730 |
679 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
579 |
525 |
$14K |
| D0274 |
Bitewings - four radiographic images |
577 |
485 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,204 |
1,069 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
981 |
725 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
104 |
85 |
$5K |
| D1351 |
Sealant - per tooth |
44 |
29 |
$4K |
| D4341 |
|
23 |
12 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
153 |
141 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
240 |
223 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
162 |
155 |
$2K |
| D9110 |
|
34 |
30 |
$1K |
| D0330 |
Panoramic radiographic image |
63 |
52 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
12 |
$555.30 |