| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,433 |
1,410 |
$110K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,502 |
1,325 |
$34K |
| D1120 |
Prophylaxis - child |
1,419 |
1,393 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
1,699 |
1,632 |
$16K |
| D1206 |
Topical application of fluoride varnish |
1,269 |
1,255 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
130 |
65 |
$11K |
| D0274 |
Bitewings - four radiographic images |
328 |
315 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
85 |
85 |
$7K |
| D1351 |
Sealant - per tooth |
81 |
13 |
$4K |
| D2140 |
|
47 |
27 |
$2K |
| D1110 |
Prophylaxis - adult |
70 |
70 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
21 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
149 |
148 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
88 |
42 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
25 |
25 |
$743.72 |