| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
1,371 |
1,015 |
$42K |
| D1120 |
Prophylaxis - child |
1,529 |
1,272 |
$40K |
| D1206 |
Topical application of fluoride varnish |
1,617 |
1,343 |
$35K |
| D0330 |
Panoramic radiographic image |
1,154 |
948 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
876 |
690 |
$28K |
| D0274 |
Bitewings - four radiographic images |
1,022 |
814 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
572 |
526 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
932 |
771 |
$10K |
| D4341 |
|
60 |
15 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
614 |
246 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
61 |
55 |
$4K |
| D1351 |
Sealant - per tooth |
121 |
19 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
25 |
14 |
$3K |
| D0272 |
Bitewings - two radiographic images |
17 |
14 |
$223.30 |