| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,191 |
2,797 |
$95K |
| D0120 |
Periodic oral evaluation - established patient |
2,899 |
2,528 |
$67K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,937 |
1,754 |
$47K |
| D0272 |
Bitewings - two radiographic images |
489 |
479 |
$12K |
| D1206 |
Topical application of fluoride varnish |
1,025 |
865 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
437 |
394 |
$7K |
| D0274 |
Bitewings - four radiographic images |
148 |
120 |
$5K |
| D1351 |
Sealant - per tooth |
67 |
24 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
121 |
79 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
36 |
12 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
16 |
16 |
$955.50 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$611.52 |
| D9310 |
|
13 |
13 |
$0.00 |
| D1999 |
|
15 |
15 |
$0.00 |
| D8660 |
|
12 |
12 |
$0.00 |