| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
690 |
637 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
810 |
748 |
$13K |
| D1110 |
Prophylaxis - adult |
354 |
315 |
$12K |
| D1120 |
Prophylaxis - child |
464 |
447 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,417 |
1,035 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
308 |
274 |
$11K |
| D0274 |
Bitewings - four radiographic images |
647 |
535 |
$10K |
| D1206 |
Topical application of fluoride varnish |
1,115 |
1,021 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,235 |
1,052 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
89 |
87 |
$8K |
| D1351 |
Sealant - per tooth |
277 |
45 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
89 |
39 |
$6K |
| D0330 |
Panoramic radiographic image |
78 |
70 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
98 |
88 |
$1K |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$205.74 |
| D0603 |
|
1,101 |
1,033 |
$0.51 |
| D0602 |
|
417 |
389 |
$0.14 |
| D0601 |
|
48 |
41 |
$0.08 |
| D1999 |
|
88 |
71 |
$0.00 |