| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,347 |
1,276 |
$38K |
| D1206 |
Topical application of fluoride varnish |
2,698 |
2,555 |
$35K |
| D0120 |
Periodic oral evaluation - established patient |
2,089 |
1,966 |
$34K |
| D0274 |
Bitewings - four radiographic images |
1,242 |
1,169 |
$23K |
| D1120 |
Prophylaxis - child |
977 |
924 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
359 |
314 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,518 |
1,445 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,271 |
1,007 |
$8K |
| D0330 |
Panoramic radiographic image |
375 |
339 |
$6K |
| D1351 |
Sealant - per tooth |
278 |
90 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
94 |
88 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
231 |
214 |
$4K |
| D0272 |
Bitewings - two radiographic images |
137 |
126 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
45 |
39 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
31 |
29 |
$673.44 |
| D0191 |
|
621 |
573 |
$0.00 |
| D0603 |
|
308 |
285 |
$0.00 |
| D0601 |
|
40 |
34 |
$0.00 |
| D1330 |
|
95 |
91 |
$0.00 |
| D0602 |
|
12 |
12 |
$0.00 |