| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
476 |
456 |
$21K |
| D1120 |
Prophylaxis - child |
439 |
423 |
$21K |
| D1351 |
Sealant - per tooth |
762 |
125 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
646 |
613 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
373 |
348 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
208 |
194 |
$11K |
| D0274 |
Bitewings - four radiographic images |
450 |
428 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
940 |
655 |
$5K |
| D0330 |
Panoramic radiographic image |
151 |
142 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
382 |
358 |
$4K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
14 |
13 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
110 |
104 |
$3K |
| D2950 |
|
39 |
29 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
31 |
13 |
$996.12 |
| D0272 |
Bitewings - two radiographic images |
16 |
16 |
$305.44 |