| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0220 |
Intraoral - periapical first radiographic image |
1,296 |
1,243 |
$26K |
| D1206 |
Topical application of fluoride varnish |
1,042 |
1,024 |
$26K |
| D1120 |
Prophylaxis - child |
626 |
617 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
741 |
735 |
$23K |
| D1110 |
Prophylaxis - adult |
390 |
376 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
286 |
271 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
927 |
892 |
$16K |
| D0272 |
Bitewings - two radiographic images |
453 |
452 |
$13K |
| D0274 |
Bitewings - four radiographic images |
258 |
251 |
$11K |
| D0330 |
Panoramic radiographic image |
98 |
96 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
77 |
48 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
154 |
150 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
121 |
83 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
21 |
14 |
$3K |
| D2140 |
|
36 |
29 |
$2K |
| D1351 |
Sealant - per tooth |
91 |
27 |
$2K |