| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,529 |
4,513 |
$246K |
| D1120 |
Prophylaxis - child |
5,236 |
5,228 |
$197K |
| D0230 |
Intraoral - periapical each additional radiographic image |
23,988 |
4,317 |
$95K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,346 |
846 |
$89K |
| D1206 |
Topical application of fluoride varnish |
5,251 |
5,239 |
$63K |
| D0274 |
Bitewings - four radiographic images |
1,465 |
1,463 |
$31K |
| D0272 |
Bitewings - two radiographic images |
2,524 |
2,523 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
645 |
645 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
241 |
241 |
$16K |
| D1351 |
Sealant - per tooth |
248 |
73 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
173 |
171 |
$2K |
| D0350 |
|
86 |
67 |
$818.40 |
| D1330 |
|
139 |
139 |
$0.00 |
| D1310 |
|
154 |
154 |
$0.00 |
| D0601 |
|
14 |
14 |
$0.00 |