| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,800 |
1,689 |
$72K |
| D0120 |
Periodic oral evaluation - established patient |
2,193 |
2,048 |
$59K |
| D1351 |
Sealant - per tooth |
618 |
336 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,483 |
1,386 |
$38K |
| D0274 |
Bitewings - four radiographic images |
990 |
916 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
2,109 |
1,964 |
$12K |
| D1110 |
Prophylaxis - adult |
293 |
269 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,885 |
1,715 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
335 |
321 |
$7K |
| D0330 |
Panoramic radiographic image |
174 |
164 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
53 |
41 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
165 |
158 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
33 |
25 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
52 |
40 |
$2K |
| D0272 |
Bitewings - two radiographic images |
128 |
121 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
46 |
43 |
$980.20 |
| D2140 |
|
20 |
13 |
$617.00 |
| D1999 |
|
28 |
28 |
$0.00 |