| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
846 |
782 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,524 |
1,418 |
$31K |
| D0274 |
Bitewings - four radiographic images |
945 |
867 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
647 |
587 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
318 |
167 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
990 |
914 |
$23K |
| D1110 |
Prophylaxis - adult |
677 |
633 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
208 |
98 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,055 |
965 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
890 |
677 |
$10K |
| D1351 |
Sealant - per tooth |
104 |
24 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
126 |
119 |
$3K |
| D2332 |
|
18 |
13 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
12 |
$525.20 |