| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,477 |
1,442 |
$87K |
| D0120 |
Periodic oral evaluation - established patient |
1,452 |
1,443 |
$85K |
| D4910 |
|
801 |
796 |
$78K |
| D1120 |
Prophylaxis - child |
1,383 |
1,364 |
$59K |
| D4341 |
|
893 |
241 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,986 |
1,953 |
$39K |
| D0210 |
Intraoral - complete series of radiographic images |
949 |
921 |
$33K |
| D1351 |
Sealant - per tooth |
811 |
166 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,494 |
1,881 |
$21K |
| D0274 |
Bitewings - four radiographic images |
1,074 |
1,069 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,241 |
1,208 |
$12K |
| D9430 |
|
393 |
342 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
39 |
24 |
$3K |
| D0272 |
Bitewings - two radiographic images |
200 |
195 |
$2K |
| D9999 |
Unspecified adjunctive procedure, by report |
27 |
27 |
$2K |
| D0999 |
Unspecified diagnostic procedure, by report |
18 |
18 |
$1K |
| D1999 |
|
115 |
92 |
$460.00 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$269.00 |