| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,426 |
1,336 |
$94K |
| D0120 |
Periodic oral evaluation - established patient |
2,432 |
2,214 |
$91K |
| D1206 |
Topical application of fluoride varnish |
2,615 |
2,461 |
$80K |
| D0274 |
Bitewings - four radiographic images |
1,385 |
1,299 |
$67K |
| D0220 |
Intraoral - periapical first radiographic image |
2,479 |
2,326 |
$56K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
278 |
184 |
$55K |
| D1120 |
Prophylaxis - child |
1,070 |
1,025 |
$53K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,624 |
2,243 |
$44K |
| D1351 |
Sealant - per tooth |
775 |
118 |
$25K |
| D0272 |
Bitewings - two radiographic images |
362 |
351 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
23 |
14 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
33 |
31 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$1K |
| D0602 |
|
2,729 |
2,530 |
$0.00 |