| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
10,958 |
10,933 |
$599K |
| D1120 |
Prophylaxis - child |
12,510 |
12,472 |
$484K |
| D0230 |
Intraoral - periapical each additional radiographic image |
41,002 |
12,016 |
$163K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,728 |
12,692 |
$161K |
| D0274 |
Bitewings - four radiographic images |
6,304 |
6,284 |
$133K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,955 |
1,007 |
$130K |
| D1351 |
Sealant - per tooth |
4,015 |
1,233 |
$105K |
| D0272 |
Bitewings - two radiographic images |
4,950 |
4,934 |
$58K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
520 |
514 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
229 |
140 |
$12K |
| D0145 |
Oral evaluation for a patient under three years of age |
155 |
155 |
$7K |
| D0350 |
|
489 |
277 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
277 |
271 |
$3K |
| D1999 |
|
322 |
321 |
$10.00 |
| D1330 |
|
23 |
23 |
$0.00 |