| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
15,397 |
15,042 |
$381K |
| D1110 |
Prophylaxis - adult |
8,653 |
8,463 |
$327K |
| D1206 |
Topical application of fluoride varnish |
16,749 |
16,370 |
$292K |
| D1120 |
Prophylaxis - child |
8,135 |
7,920 |
$189K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,638 |
785 |
$105K |
| D0274 |
Bitewings - four radiographic images |
6,485 |
6,354 |
$93K |
| D0330 |
Panoramic radiographic image |
2,271 |
2,227 |
$87K |
| D1351 |
Sealant - per tooth |
3,099 |
684 |
$71K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,217 |
1,182 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
4,817 |
4,680 |
$39K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
87 |
85 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
505 |
154 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
306 |
174 |
$22K |
| D0272 |
Bitewings - two radiographic images |
1,631 |
1,606 |
$16K |
| D2160 |
|
167 |
85 |
$14K |
| D2140 |
|
206 |
103 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,577 |
3,484 |
$8K |
| D9999 |
Unspecified adjunctive procedure, by report |
197 |
196 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
240 |
235 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
12 |
$1K |