| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,420 |
2,375 |
$116K |
| D0274 |
Bitewings - four radiographic images |
1,863 |
1,802 |
$51K |
| D1206 |
Topical application of fluoride varnish |
1,838 |
1,819 |
$42K |
| D1120 |
Prophylaxis - child |
1,597 |
1,581 |
$40K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
396 |
225 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
817 |
748 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
2,649 |
2,367 |
$34K |
| D1110 |
Prophylaxis - adult |
1,114 |
1,073 |
$34K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
440 |
245 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
344 |
341 |
$27K |
| D0330 |
Panoramic radiographic image |
567 |
558 |
$23K |
| D0272 |
Bitewings - two radiographic images |
970 |
954 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
177 |
128 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,333 |
1,459 |
$10K |
| D2140 |
|
116 |
69 |
$6K |
| D1351 |
Sealant - per tooth |
39 |
12 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
13 |
$1K |