| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
538 |
523 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
567 |
551 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
183 |
116 |
$15K |
| D1206 |
Topical application of fluoride varnish |
487 |
476 |
$14K |
| D1110 |
Prophylaxis - adult |
147 |
143 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
57 |
56 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
53 |
36 |
$5K |
| D1351 |
Sealant - per tooth |
115 |
50 |
$5K |
| D0274 |
Bitewings - four radiographic images |
112 |
109 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
205 |
193 |
$4K |
| D1354 |
|
138 |
48 |
$4K |
| D0272 |
Bitewings - two radiographic images |
171 |
165 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
38 |
37 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$560.95 |