| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
6,778 |
4,597 |
$141K |
| D0120 |
Periodic oral evaluation - established patient |
2,570 |
2,514 |
$67K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,772 |
1,751 |
$43K |
| D1110 |
Prophylaxis - adult |
2,262 |
2,211 |
$40K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
701 |
466 |
$37K |
| D0210 |
Intraoral - complete series of radiographic images |
767 |
763 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
858 |
548 |
$26K |
| D0330 |
Panoramic radiographic image |
1,598 |
1,551 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
1,392 |
1,351 |
$17K |
| D1120 |
Prophylaxis - child |
1,342 |
1,322 |
$8K |
| D0274 |
Bitewings - four radiographic images |
3,620 |
3,541 |
$5K |
| D8670 |
Periodic orthodontic treatment visit |
58 |
46 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
4,961 |
4,838 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,158 |
2,109 |
$2K |
| D1354 |
|
344 |
107 |
$2K |
| D1351 |
Sealant - per tooth |
340 |
110 |
$2K |
| D7111 |
|
21 |
12 |
$1K |
| D1330 |
|
3,956 |
3,864 |
$965.56 |
| D1206 |
Topical application of fluoride varnish |
1,002 |
986 |
$914.90 |
| D0272 |
Bitewings - two radiographic images |
586 |
567 |
$422.83 |
| D1999 |
|
58 |
58 |
$80.13 |
| D9986 |
|
269 |
263 |
$0.00 |
| D0270 |
|
12 |
12 |
$0.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
30 |
30 |
$0.00 |
| D9210 |
|
21 |
19 |
$0.00 |