| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0274 |
Bitewings - four radiographic images |
7,303 |
7,084 |
$210K |
| D1110 |
Prophylaxis - adult |
4,209 |
4,100 |
$174K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,378 |
7,428 |
$145K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,134 |
3,994 |
$143K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,356 |
6,184 |
$108K |
| D0220 |
Intraoral - periapical first radiographic image |
7,855 |
7,601 |
$90K |
| D1120 |
Prophylaxis - child |
2,564 |
2,491 |
$79K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
861 |
534 |
$73K |
| D4346 |
|
585 |
572 |
$58K |
| D0120 |
Periodic oral evaluation - established patient |
1,556 |
1,531 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
1,141 |
1,094 |
$34K |
| D1351 |
Sealant - per tooth |
861 |
190 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
121 |
89 |
$14K |
| D0330 |
Panoramic radiographic image |
107 |
105 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
50 |
26 |
$3K |