| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,670 |
2,492 |
$127K |
| D0120 |
Periodic oral evaluation - established patient |
4,397 |
4,142 |
$111K |
| D0274 |
Bitewings - four radiographic images |
2,912 |
2,744 |
$83K |
| D1351 |
Sealant - per tooth |
2,876 |
352 |
$69K |
| D1120 |
Prophylaxis - child |
2,022 |
1,916 |
$67K |
| D1206 |
Topical application of fluoride varnish |
4,176 |
3,950 |
$55K |
| D0220 |
Intraoral - periapical first radiographic image |
4,052 |
3,841 |
$45K |
| D0145 |
Oral evaluation for a patient under three years of age |
341 |
319 |
$44K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,927 |
3,602 |
$39K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
344 |
119 |
$30K |
| D0272 |
Bitewings - two radiographic images |
849 |
809 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
335 |
305 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
425 |
388 |
$12K |
| D0330 |
Panoramic radiographic image |
272 |
249 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$261.17 |
| D0601 |
|
1,983 |
1,897 |
$0.00 |
| D0602 |
|
3,067 |
2,934 |
$0.00 |
| D0603 |
|
137 |
132 |
$0.00 |
| D1999 |
|
1,069 |
985 |
$0.00 |