| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,889 |
2,766 |
$116K |
| D0120 |
Periodic oral evaluation - established patient |
2,692 |
2,574 |
$73K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,721 |
2,607 |
$70K |
| D1351 |
Sealant - per tooth |
135 |
95 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,556 |
1,480 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
397 |
354 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,385 |
1,321 |
$7K |
| D1110 |
Prophylaxis - adult |
185 |
171 |
$7K |
| D0274 |
Bitewings - four radiographic images |
400 |
375 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
41 |
30 |
$3K |
| D0330 |
Panoramic radiographic image |
138 |
125 |
$3K |
| D0272 |
Bitewings - two radiographic images |
223 |
218 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
100 |
87 |
$714.20 |
| D1999 |
|
34 |
33 |
$0.00 |