| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
6,732 |
6,198 |
$188K |
| D1110 |
Prophylaxis - adult |
3,334 |
3,260 |
$167K |
| D1120 |
Prophylaxis - child |
3,272 |
3,246 |
$129K |
| D1206 |
Topical application of fluoride varnish |
3,137 |
3,125 |
$89K |
| D0274 |
Bitewings - four radiographic images |
2,525 |
2,459 |
$81K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
682 |
514 |
$54K |
| D0140 |
Limited oral evaluation - problem focused |
1,314 |
1,229 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
400 |
286 |
$22K |
| D0330 |
Panoramic radiographic image |
482 |
471 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
576 |
527 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,090 |
1,080 |
$14K |
| D1351 |
Sealant - per tooth |
309 |
168 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
263 |
257 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
456 |
351 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
31 |
25 |
$3K |
| D9420 |
|
40 |
40 |
$2K |
| D0272 |
Bitewings - two radiographic images |
104 |
102 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
151 |
150 |
$2K |
| D2335 |
|
17 |
12 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
13 |
12 |
$1K |
| D0270 |
|
15 |
15 |
$193.92 |
| D0190 |
|
31 |
31 |
$0.00 |
| D1310 |
|
55 |
55 |
$0.00 |