| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
8,709 |
8,229 |
$211K |
| D1110 |
Prophylaxis - adult |
5,659 |
5,340 |
$200K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,919 |
802 |
$138K |
| D1120 |
Prophylaxis - child |
3,737 |
3,537 |
$97K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
974 |
602 |
$93K |
| D0274 |
Bitewings - four radiographic images |
2,679 |
2,535 |
$80K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,026 |
4,735 |
$80K |
| D0330 |
Panoramic radiographic image |
1,513 |
1,410 |
$71K |
| D0140 |
Limited oral evaluation - problem focused |
1,814 |
1,670 |
$60K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,402 |
1,301 |
$56K |
| D0272 |
Bitewings - two radiographic images |
1,690 |
1,597 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
2,078 |
1,897 |
$28K |
| D2330 |
|
115 |
70 |
$7K |
| D1206 |
Topical application of fluoride varnish |
190 |
185 |
$3K |
| D4355 |
|
50 |
43 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
248 |
165 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
27 |
26 |
$2K |
| D2331 |
|
21 |
15 |
$1K |