| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,887 |
4,871 |
$169K |
| D1110 |
Prophylaxis - adult |
3,349 |
3,339 |
$153K |
| D0272 |
Bitewings - two radiographic images |
7,098 |
7,057 |
$144K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,802 |
6,777 |
$122K |
| D1120 |
Prophylaxis - child |
3,811 |
3,798 |
$118K |
| D0220 |
Intraoral - periapical first radiographic image |
8,260 |
8,110 |
$94K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,141 |
742 |
$84K |
| D0140 |
Limited oral evaluation - problem focused |
2,545 |
2,440 |
$75K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,831 |
7,496 |
$72K |
| D0120 |
Periodic oral evaluation - established patient |
1,993 |
1,988 |
$45K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
465 |
308 |
$26K |
| D0330 |
Panoramic radiographic image |
499 |
496 |
$23K |
| D0274 |
Bitewings - four radiographic images |
154 |
154 |
$5K |
| D1351 |
Sealant - per tooth |
159 |
27 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
16 |
$1K |