| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,840 |
2,631 |
$70K |
| D1110 |
Prophylaxis - adult |
1,454 |
1,319 |
$68K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,743 |
2,417 |
$44K |
| D0274 |
Bitewings - four radiographic images |
1,368 |
1,248 |
$40K |
| D1120 |
Prophylaxis - child |
1,026 |
977 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,345 |
2,184 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
2,607 |
2,418 |
$29K |
| D1351 |
Sealant - per tooth |
738 |
183 |
$18K |
| D0145 |
Oral evaluation for a patient under three years of age |
118 |
111 |
$15K |
| D0272 |
Bitewings - two radiographic images |
521 |
487 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
73 |
40 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
105 |
54 |
$7K |
| D1206 |
Topical application of fluoride varnish |
468 |
461 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
94 |
93 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
27 |
25 |
$810.98 |
| D1330 |
|
266 |
264 |
$560.50 |
| D0350 |
|
23 |
14 |
$70.00 |
| D0602 |
|
888 |
834 |
$0.00 |
| D0603 |
|
1,943 |
1,844 |
$0.00 |
| D0601 |
|
127 |
121 |
$0.00 |