| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,397 |
1,339 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
993 |
955 |
$26K |
| D0210 |
Intraoral - complete series of radiographic images |
514 |
508 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
990 |
939 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
668 |
646 |
$17K |
| D1206 |
Topical application of fluoride varnish |
535 |
502 |
$17K |
| D1120 |
Prophylaxis - child |
339 |
323 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
322 |
300 |
$14K |
| D1351 |
Sealant - per tooth |
379 |
38 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
2,033 |
1,820 |
$8K |
| D0274 |
Bitewings - four radiographic images |
1,039 |
986 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,655 |
1,530 |
$6K |
| D0330 |
Panoramic radiographic image |
520 |
484 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
41 |
12 |
$2K |
| D1999 |
|
364 |
295 |
$0.00 |