| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
648 |
618 |
$27K |
| D1120 |
Prophylaxis - child |
572 |
547 |
$26K |
| D1351 |
Sealant - per tooth |
1,451 |
259 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
474 |
435 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
234 |
218 |
$13K |
| D0274 |
Bitewings - four radiographic images |
474 |
454 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
732 |
694 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
437 |
418 |
$8K |
| D1353 |
|
571 |
123 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
282 |
101 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
245 |
232 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
641 |
560 |
$3K |
| D0330 |
Panoramic radiographic image |
91 |
80 |
$3K |
| D0270 |
|
34 |
31 |
$330.12 |