| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,821 |
2,794 |
$94K |
| D1110 |
Prophylaxis - adult |
1,341 |
1,326 |
$87K |
| D1120 |
Prophylaxis - child |
1,520 |
1,511 |
$71K |
| D1206 |
Topical application of fluoride varnish |
2,785 |
2,761 |
$63K |
| D9110 |
|
1,056 |
1,030 |
$58K |
| D0274 |
Bitewings - four radiographic images |
1,162 |
1,151 |
$47K |
| D0330 |
Panoramic radiographic image |
701 |
686 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
261 |
249 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
500 |
474 |
$6K |
| D1351 |
Sealant - per tooth |
127 |
39 |
$4K |
| D9986 |
|
154 |
147 |
$3K |
| D2331 |
|
21 |
12 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17 |
14 |
$2K |
| D2940 |
|
35 |
27 |
$2K |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$405.03 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$43.27 |