| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,468 |
3,348 |
$142K |
| D0120 |
Periodic oral evaluation - established patient |
3,239 |
3,131 |
$91K |
| D1206 |
Topical application of fluoride varnish |
3,390 |
3,266 |
$88K |
| D1351 |
Sealant - per tooth |
270 |
213 |
$33K |
| D0330 |
Panoramic radiographic image |
1,269 |
1,221 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
515 |
486 |
$11K |
| D0272 |
Bitewings - two radiographic images |
886 |
843 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
321 |
320 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
18 |
13 |
$1K |
| D1999 |
|
24 |
24 |
$0.00 |