| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,696 |
2,621 |
$169K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,514 |
1,462 |
$140K |
| D0274 |
Bitewings - four radiographic images |
2,489 |
2,413 |
$69K |
| D1110 |
Prophylaxis - adult |
1,644 |
1,575 |
$43K |
| D1120 |
Prophylaxis - child |
2,221 |
2,186 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
2,224 |
2,055 |
$31K |
| D1206 |
Topical application of fluoride varnish |
2,911 |
2,859 |
$27K |
| D2140 |
|
456 |
193 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,098 |
1,476 |
$19K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
244 |
99 |
$15K |
| D0330 |
Panoramic radiographic image |
680 |
657 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
219 |
205 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
104 |
46 |
$7K |
| D1351 |
Sealant - per tooth |
212 |
29 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
151 |
145 |
$5K |