| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,495 |
1,447 |
$41K |
| D1120 |
Prophylaxis - child |
828 |
789 |
$34K |
| D1110 |
Prophylaxis - adult |
507 |
482 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
576 |
560 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
475 |
461 |
$13K |
| D0274 |
Bitewings - four radiographic images |
563 |
544 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
320 |
315 |
$10K |
| D1351 |
Sealant - per tooth |
105 |
57 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
216 |
214 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
379 |
372 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
12 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
134 |
134 |
$990.08 |
| D1999 |
|
189 |
128 |
$0.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
35 |
30 |
$0.00 |