| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,499 |
1,472 |
$45K |
| D1120 |
Prophylaxis - child |
999 |
976 |
$44K |
| D1110 |
Prophylaxis - adult |
699 |
685 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,747 |
1,710 |
$40K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
213 |
106 |
$25K |
| D0274 |
Bitewings - four radiographic images |
775 |
759 |
$18K |
| D1351 |
Sealant - per tooth |
289 |
38 |
$9K |
| D0330 |
Panoramic radiographic image |
145 |
144 |
$7K |
| D1330 |
|
958 |
944 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
119 |
112 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
69 |
58 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
102 |
99 |
$983.83 |
| D0210 |
Intraoral - complete series of radiographic images |
18 |
13 |
$684.00 |