| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,685 |
1,677 |
$50K |
| D1120 |
Prophylaxis - child |
745 |
742 |
$33K |
| D1110 |
Prophylaxis - adult |
691 |
684 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
374 |
225 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
794 |
790 |
$20K |
| D1206 |
Topical application of fluoride varnish |
480 |
480 |
$15K |
| D0330 |
Panoramic radiographic image |
247 |
239 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
166 |
164 |
$7K |
| D0274 |
Bitewings - four radiographic images |
520 |
511 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
117 |
117 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
1,016 |
954 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
82 |
61 |
$4K |
| D1351 |
Sealant - per tooth |
210 |
38 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
230 |
226 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
385 |
369 |
$2K |
| D2954 |
|
15 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
140 |
140 |
$1K |