| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
18,797 |
18,797 |
$697K |
| D0230 |
Intraoral - periapical each additional radiographic image |
56,606 |
18,108 |
$673K |
| D1120 |
Prophylaxis - child |
13,161 |
13,161 |
$438K |
| D0274 |
Bitewings - four radiographic images |
9,500 |
9,499 |
$404K |
| D0220 |
Intraoral - periapical first radiographic image |
19,513 |
19,410 |
$313K |
| D1208 |
Topical application of fluoride, excluding varnish |
18,540 |
18,540 |
$260K |
| D1110 |
Prophylaxis - adult |
4,440 |
4,440 |
$222K |
| D0330 |
Panoramic radiographic image |
2,501 |
2,501 |
$185K |
| D0272 |
Bitewings - two radiographic images |
5,895 |
5,895 |
$152K |
| D1351 |
Sealant - per tooth |
2,262 |
565 |
$85K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
849 |
516 |
$54K |
| D2160 |
|
238 |
152 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
403 |
399 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
70 |
47 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
85 |
55 |
$11K |
| D2140 |
|
65 |
41 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
21 |
12 |
$1K |