| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,668 |
3,653 |
$202K |
| D1120 |
Prophylaxis - child |
3,174 |
3,159 |
$117K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,461 |
4,284 |
$96K |
| D1110 |
Prophylaxis - adult |
1,028 |
1,016 |
$86K |
| D0274 |
Bitewings - four radiographic images |
3,226 |
3,188 |
$67K |
| D9430 |
|
1,786 |
1,628 |
$57K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,591 |
3,563 |
$42K |
| D1351 |
Sealant - per tooth |
1,675 |
451 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
615 |
607 |
$37K |
| D4910 |
|
324 |
315 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
506 |
504 |
$23K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
139 |
58 |
$9K |
| D0272 |
Bitewings - two radiographic images |
561 |
559 |
$6K |
| D4341 |
|
44 |
13 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
34 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
125 |
124 |
$1K |
| D1999 |
|
607 |
566 |
$0.00 |