| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,400 |
2,306 |
$59K |
| D0330 |
Panoramic radiographic image |
1,043 |
978 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,196 |
1,123 |
$49K |
| D1110 |
Prophylaxis - adult |
1,217 |
1,177 |
$44K |
| D1120 |
Prophylaxis - child |
1,446 |
1,381 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
2,362 |
2,187 |
$33K |
| D1206 |
Topical application of fluoride varnish |
2,075 |
1,976 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,162 |
1,382 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,047 |
983 |
$30K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
110 |
71 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
226 |
220 |
$8K |
| D0272 |
Bitewings - two radiographic images |
245 |
244 |
$5K |
| D1351 |
Sealant - per tooth |
108 |
24 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19 |
14 |
$1K |