| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,218 |
2,045 |
$50K |
| D1110 |
Prophylaxis - adult |
1,086 |
984 |
$43K |
| D1120 |
Prophylaxis - child |
969 |
904 |
$41K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
693 |
423 |
$38K |
| D0330 |
Panoramic radiographic image |
1,016 |
937 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,110 |
1,946 |
$29K |
| D0274 |
Bitewings - four radiographic images |
1,175 |
1,087 |
$26K |
| D1351 |
Sealant - per tooth |
551 |
150 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
258 |
239 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
865 |
770 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
114 |
70 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
112 |
50 |
$560.34 |
| D0272 |
Bitewings - two radiographic images |
25 |
25 |
$415.87 |
| D0120 |
Periodic oral evaluation - established patient |
14 |
14 |
$323.50 |