| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
3,726 |
2,247 |
$67K |
| D0210 |
Intraoral - complete series of radiographic images |
1,535 |
1,482 |
$44K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,641 |
923 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
1,935 |
1,888 |
$21K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
404 |
257 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,915 |
1,841 |
$17K |
| D1110 |
Prophylaxis - adult |
1,824 |
1,769 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,416 |
658 |
$15K |
| D0340 |
|
101 |
100 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,248 |
3,148 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
868 |
836 |
$5K |
| D1330 |
|
3,339 |
3,237 |
$3K |
| D1120 |
Prophylaxis - child |
468 |
460 |
$3K |
| D0330 |
Panoramic radiographic image |
73 |
73 |
$2K |
| D0274 |
Bitewings - four radiographic images |
1,390 |
1,349 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
3,143 |
3,020 |
$1K |
| D1351 |
Sealant - per tooth |
169 |
41 |
$136.32 |
| D0272 |
Bitewings - two radiographic images |
26 |
26 |
$55.08 |
| D0270 |
|
17 |
17 |
$24.12 |
| D0350 |
|
421 |
403 |
$14.06 |
| D1999 |
|
4,319 |
3,891 |
$0.00 |