| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
10,301 |
10,248 |
$604K |
| D1120 |
Prophylaxis - child |
10,125 |
10,074 |
$396K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,893 |
2,478 |
$257K |
| D1110 |
Prophylaxis - adult |
2,974 |
2,958 |
$253K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,598 |
2,593 |
$161K |
| D1206 |
Topical application of fluoride varnish |
10,336 |
10,282 |
$154K |
| D1351 |
Sealant - per tooth |
5,229 |
1,651 |
$149K |
| D1310 |
|
3,110 |
3,087 |
$140K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,125 |
1,426 |
$114K |
| D9993 |
|
1,861 |
1,858 |
$106K |
| D0210 |
Intraoral - complete series of radiographic images |
2,056 |
2,050 |
$96K |
| D0274 |
Bitewings - four radiographic images |
4,006 |
3,989 |
$83K |
| D9430 |
|
2,300 |
2,235 |
$73K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,587 |
6,398 |
$61K |
| D4910 |
|
710 |
710 |
$54K |
| D0350 |
|
3,597 |
1,846 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
2,929 |
2,878 |
$34K |
| D0603 |
|
1,885 |
1,869 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,835 |
1,830 |
$20K |
| D0272 |
Bitewings - two radiographic images |
1,682 |
1,673 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
192 |
149 |
$15K |
| D0145 |
Oral evaluation for a patient under three years of age |
204 |
204 |
$12K |
| D0270 |
|
1,318 |
1,294 |
$7K |
| D0601 |
|
432 |
432 |
$6K |
| D4341 |
|
86 |
27 |
$6K |
| D4342 |
|
45 |
14 |
$2K |
| D0602 |
|
98 |
98 |
$1K |
| D2330 |
|
16 |
12 |
$1K |