| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,821 |
1,780 |
$71K |
| D1120 |
Prophylaxis - child |
2,326 |
2,247 |
$65K |
| D0272 |
Bitewings - two radiographic images |
1,012 |
984 |
$20K |
| D1351 |
Sealant - per tooth |
718 |
185 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,121 |
1,080 |
$18K |
| D1206 |
Topical application of fluoride varnish |
724 |
699 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
438 |
419 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
54 |
27 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
63 |
39 |
$5K |
| D0330 |
Panoramic radiographic image |
86 |
76 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
74 |
73 |
$966.78 |
| D1999 |
|
12 |
12 |
$0.00 |