| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,410 |
1,310 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
1,715 |
1,629 |
$46K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,246 |
1,161 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,119 |
1,020 |
$25K |
| D1110 |
Prophylaxis - adult |
554 |
517 |
$22K |
| D0330 |
Panoramic radiographic image |
508 |
494 |
$12K |
| D0274 |
Bitewings - four radiographic images |
626 |
561 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
121 |
93 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
409 |
370 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
536 |
455 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
85 |
63 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
961 |
881 |
$5K |
| D9110 |
|
39 |
38 |
$2K |
| D1351 |
Sealant - per tooth |
21 |
13 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
143 |
134 |
$981.76 |