| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
6,056 |
5,749 |
$152K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,318 |
817 |
$133K |
| D1110 |
Prophylaxis - adult |
2,887 |
2,737 |
$104K |
| D1206 |
Topical application of fluoride varnish |
5,627 |
5,326 |
$88K |
| D1120 |
Prophylaxis - child |
3,177 |
2,971 |
$83K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
608 |
342 |
$69K |
| D0220 |
Intraoral - periapical first radiographic image |
3,937 |
3,677 |
$57K |
| D0274 |
Bitewings - four radiographic images |
1,536 |
1,439 |
$45K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,589 |
3,089 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
893 |
802 |
$35K |
| D0330 |
Panoramic radiographic image |
356 |
319 |
$19K |
| D0272 |
Bitewings - two radiographic images |
181 |
178 |
$3K |
| D2394 |
|
17 |
12 |
$3K |
| D1351 |
Sealant - per tooth |
38 |
12 |
$896.61 |
| D0145 |
Oral evaluation for a patient under three years of age |
31 |
13 |
$449.15 |