| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
5,875 |
5,721 |
$139K |
| D0120 |
Periodic oral evaluation - established patient |
4,609 |
4,565 |
$108K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,058 |
560 |
$85K |
| D1120 |
Prophylaxis - child |
2,966 |
2,944 |
$83K |
| D1110 |
Prophylaxis - adult |
2,001 |
1,977 |
$69K |
| D1999 |
|
3,489 |
3,149 |
$34K |
| D0274 |
Bitewings - four radiographic images |
1,065 |
1,052 |
$19K |
| D0272 |
Bitewings - two radiographic images |
958 |
948 |
$13K |
| D0330 |
Panoramic radiographic image |
332 |
328 |
$8K |
| D1351 |
Sealant - per tooth |
278 |
55 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
293 |
291 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
156 |
144 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
47 |
40 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
25 |
16 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
254 |
241 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
19 |
19 |
$875.61 |