| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0367 |
|
356 |
328 |
$50K |
| D1206 |
Topical application of fluoride varnish |
518 |
497 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,284 |
1,152 |
$12K |
| D0381 |
|
92 |
86 |
$12K |
| D0382 |
|
90 |
85 |
$11K |
| D1351 |
Sealant - per tooth |
499 |
90 |
$10K |
| D1120 |
Prophylaxis - child |
217 |
209 |
$10K |
| D0330 |
Panoramic radiographic image |
752 |
660 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
301 |
288 |
$9K |
| D0274 |
Bitewings - four radiographic images |
558 |
499 |
$8K |
| D0364 |
|
51 |
50 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
289 |
261 |
$7K |
| D0160 |
|
200 |
187 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,261 |
947 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
157 |
150 |
$4K |
| D1354 |
|
283 |
52 |
$3K |
| D9630 |
|
233 |
67 |
$2K |
| D9215 |
|
203 |
175 |
$1K |
| D1110 |
Prophylaxis - adult |
13 |
13 |
$547.91 |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$235.76 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$212.10 |
| D9222 |
|
24 |
12 |
$0.00 |