| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,668 |
2,547 |
$71K |
| D1110 |
Prophylaxis - adult |
1,354 |
1,305 |
$67K |
| D1120 |
Prophylaxis - child |
1,430 |
1,376 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,270 |
3,137 |
$44K |
| D0274 |
Bitewings - four radiographic images |
1,237 |
1,187 |
$36K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
291 |
136 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,237 |
828 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,025 |
976 |
$12K |
| D0272 |
Bitewings - two radiographic images |
557 |
539 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
264 |
258 |
$9K |
| D0330 |
Panoramic radiographic image |
243 |
236 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
103 |
99 |
$6K |
| D1351 |
Sealant - per tooth |
70 |
14 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20 |
12 |
$2K |
| D1206 |
Topical application of fluoride varnish |
14 |
13 |
$191.10 |
| D0603 |
|
1,610 |
1,570 |
$0.00 |
| D0602 |
|
766 |
750 |
$0.00 |
| D0601 |
|
406 |
395 |
$0.00 |