| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,745 |
1,680 |
$69K |
| D0120 |
Periodic oral evaluation - established patient |
2,410 |
2,289 |
$65K |
| D0274 |
Bitewings - four radiographic images |
1,235 |
1,185 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
965 |
907 |
$16K |
| D1110 |
Prophylaxis - adult |
437 |
397 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
476 |
465 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,622 |
1,511 |
$9K |
| D1206 |
Topical application of fluoride varnish |
294 |
262 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
148 |
113 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
341 |
323 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
166 |
117 |
$6K |
| D1351 |
Sealant - per tooth |
83 |
33 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
671 |
641 |
$3K |
| D0272 |
Bitewings - two radiographic images |
235 |
223 |
$2K |
| D9110 |
|
14 |
13 |
$700.00 |
| D0210 |
Intraoral - complete series of radiographic images |
29 |
29 |
$619.10 |
| D0270 |
|
71 |
67 |
$386.40 |