| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0220 |
Intraoral - periapical first radiographic image |
4,804 |
3,865 |
$1.38M |
| D0140 |
Limited oral evaluation - problem focused |
1,222 |
1,098 |
$738K |
| D0120 |
Periodic oral evaluation - established patient |
2,285 |
1,944 |
$307K |
| D1110 |
Prophylaxis - adult |
1,523 |
1,274 |
$290K |
| D1120 |
Prophylaxis - child |
306 |
277 |
$134K |
| D1208 |
Topical application of fluoride, excluding varnish |
670 |
607 |
$55K |
| D1206 |
Topical application of fluoride varnish |
1,155 |
957 |
$51K |
| D0274 |
Bitewings - four radiographic images |
1,947 |
1,654 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
264 |
206 |
$49K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
145 |
77 |
$32K |
| D0330 |
Panoramic radiographic image |
868 |
751 |
$30K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
101 |
49 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,573 |
2,132 |
$15K |
| D4910 |
|
73 |
65 |
$5K |
| D4346 |
|
19 |
18 |
$500.36 |
| D1330 |
|
3,580 |
2,966 |
$0.00 |
| D9630 |
|
19 |
14 |
$0.00 |
| D1310 |
|
51 |
37 |
$0.00 |