| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
9,828 |
9,764 |
$208K |
| D0274 |
Bitewings - four radiographic images |
6,150 |
6,100 |
$189K |
| D1120 |
Prophylaxis - child |
6,291 |
6,248 |
$188K |
| D1110 |
Prophylaxis - adult |
4,310 |
4,281 |
$127K |
| D1206 |
Topical application of fluoride varnish |
7,232 |
7,203 |
$120K |
| D1351 |
Sealant - per tooth |
1,810 |
926 |
$73K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
665 |
485 |
$65K |
| D0210 |
Intraoral - complete series of radiographic images |
1,051 |
1,051 |
$65K |
| D0272 |
Bitewings - two radiographic images |
3,003 |
2,983 |
$61K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,946 |
2,904 |
$49K |
| D0330 |
Panoramic radiographic image |
642 |
632 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
409 |
392 |
$5K |
| D9630 |
|
158 |
152 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
41 |
40 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
53 |
50 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
12 |
$879.57 |