| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,378 |
1,349 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
2,303 |
2,222 |
$9K |
| D1110 |
Prophylaxis - adult |
573 |
552 |
$9K |
| D0274 |
Bitewings - four radiographic images |
869 |
838 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,185 |
1,146 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,829 |
1,688 |
$6K |
| D1120 |
Prophylaxis - child |
438 |
425 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
205 |
184 |
$1K |
| D1999 |
|
321 |
294 |
$1K |
| D0272 |
Bitewings - two radiographic images |
163 |
157 |
$603.17 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
43 |
41 |
$453.92 |
| D1206 |
Topical application of fluoride varnish |
20 |
20 |
$329.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
28 |
16 |
$145.34 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
34 |
13 |
$120.32 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$46.04 |
| D1351 |
Sealant - per tooth |
30 |
12 |
$0.00 |