| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,533 |
4,360 |
$186K |
| D0120 |
Periodic oral evaluation - established patient |
4,529 |
4,356 |
$126K |
| D1206 |
Topical application of fluoride varnish |
3,516 |
3,379 |
$91K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,128 |
940 |
$78K |
| D0274 |
Bitewings - four radiographic images |
1,656 |
1,601 |
$29K |
| D0272 |
Bitewings - two radiographic images |
1,221 |
1,163 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
297 |
250 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
176 |
173 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
357 |
354 |
$2K |
| D1351 |
Sealant - per tooth |
21 |
14 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
70 |
68 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
52 |
52 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
33 |
31 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
176 |
176 |
$907.56 |
| D1999 |
|
545 |
416 |
$0.00 |