| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,732 |
2,586 |
$66K |
| D1110 |
Prophylaxis - adult |
1,387 |
1,308 |
$48K |
| D1120 |
Prophylaxis - child |
1,233 |
1,157 |
$31K |
| D1206 |
Topical application of fluoride varnish |
2,036 |
1,913 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
1,994 |
1,828 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,550 |
1,251 |
$18K |
| D1351 |
Sealant - per tooth |
540 |
122 |
$15K |
| D0274 |
Bitewings - four radiographic images |
425 |
418 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
84 |
51 |
$8K |
| D0330 |
Panoramic radiographic image |
136 |
129 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
42 |
24 |
$5K |
| D0272 |
Bitewings - two radiographic images |
212 |
202 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
97 |
89 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
56 |
55 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
17 |
15 |
$1K |