| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,269 |
2,244 |
$164K |
| D0120 |
Periodic oral evaluation - established patient |
3,554 |
3,475 |
$146K |
| D1206 |
Topical application of fluoride varnish |
4,742 |
4,654 |
$122K |
| D1351 |
Sealant - per tooth |
3,469 |
875 |
$101K |
| D1120 |
Prophylaxis - child |
2,707 |
2,636 |
$90K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,677 |
4,858 |
$77K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,879 |
1,836 |
$77K |
| D0220 |
Intraoral - periapical first radiographic image |
5,112 |
4,948 |
$50K |
| D0274 |
Bitewings - four radiographic images |
2,278 |
2,237 |
$42K |
| D2140 |
|
452 |
257 |
$23K |
| D0272 |
Bitewings - two radiographic images |
1,850 |
1,821 |
$17K |
| D9999 |
Unspecified adjunctive procedure, by report |
167 |
167 |
$7K |
| D7971 |
|
81 |
64 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
172 |
163 |
$5K |
| D0999 |
Unspecified diagnostic procedure, by report |
71 |
71 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
85 |
85 |
$4K |
| D1999 |
|
48 |
48 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
43 |
28 |
$2K |
| D9110 |
|
37 |
37 |
$1K |
| D0350 |
|
88 |
38 |
$864.00 |