| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,068 |
987 |
$39K |
| D1120 |
Prophylaxis - child |
989 |
943 |
$28K |
| D1351 |
Sealant - per tooth |
982 |
162 |
$24K |
| D1206 |
Topical application of fluoride varnish |
861 |
825 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
154 |
85 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
111 |
109 |
$7K |
| D0330 |
Panoramic radiographic image |
83 |
80 |
$5K |
| D0274 |
Bitewings - four radiographic images |
173 |
161 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
320 |
300 |
$4K |
| D0272 |
Bitewings - two radiographic images |
141 |
132 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
177 |
148 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
39 |
39 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
12 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
82 |
67 |
$1K |