| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,244 |
1,202 |
$25K |
| D1110 |
Prophylaxis - adult |
708 |
678 |
$22K |
| D1206 |
Topical application of fluoride varnish |
1,258 |
1,211 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
493 |
471 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,371 |
1,285 |
$10K |
| D0272 |
Bitewings - two radiographic images |
1,003 |
965 |
$9K |
| D1120 |
Prophylaxis - child |
366 |
354 |
$8K |
| D1999 |
|
487 |
316 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
288 |
260 |
$5K |
| D5110 |
|
13 |
13 |
$5K |
| D0330 |
Panoramic radiographic image |
159 |
149 |
$3K |
| D1351 |
Sealant - per tooth |
140 |
30 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,168 |
1,100 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
35 |
13 |
$2K |
| D5410 |
|
61 |
48 |
$941.36 |