| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
6,630 |
6,542 |
$188K |
| D1110 |
Prophylaxis - adult |
3,765 |
3,710 |
$186K |
| D1120 |
Prophylaxis - child |
4,753 |
4,687 |
$171K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,726 |
605 |
$119K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,325 |
5,265 |
$109K |
| D0272 |
Bitewings - two radiographic images |
3,783 |
3,728 |
$82K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
723 |
327 |
$60K |
| D0330 |
Panoramic radiographic image |
1,134 |
1,108 |
$58K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
816 |
794 |
$36K |
| D1206 |
Topical application of fluoride varnish |
839 |
821 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
516 |
505 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
75 |
71 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
23 |
12 |
$2K |
| D1351 |
Sealant - per tooth |
48 |
13 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
68 |
68 |
$960.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
43 |
30 |
$542.28 |
| D1999 |
|
40 |
40 |
$0.00 |
| D1330 |
|
39 |
37 |
$0.00 |