| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
10,858 |
2,791 |
$101K |
| D0120 |
Periodic oral evaluation - established patient |
2,651 |
2,516 |
$68K |
| D1120 |
Prophylaxis - child |
1,838 |
1,767 |
$61K |
| D1110 |
Prophylaxis - adult |
999 |
943 |
$46K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
475 |
224 |
$45K |
| D1351 |
Sealant - per tooth |
1,901 |
308 |
$44K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,119 |
2,989 |
$40K |
| D0145 |
Oral evaluation for a patient under three years of age |
289 |
281 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
3,351 |
3,193 |
$33K |
| D0272 |
Bitewings - two radiographic images |
704 |
681 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
152 |
92 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
433 |
388 |
$11K |
| D0274 |
Bitewings - four radiographic images |
758 |
696 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
238 |
217 |
$9K |
| D0330 |
Panoramic radiographic image |
146 |
141 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
27 |
26 |
$455.12 |
| D0603 |
|
3,916 |
3,804 |
$36.28 |