| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,318 |
1,275 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
2,371 |
2,284 |
$62K |
| D1120 |
Prophylaxis - child |
1,293 |
1,251 |
$44K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,755 |
2,665 |
$38K |
| D0210 |
Intraoral - complete series of radiographic images |
602 |
592 |
$30K |
| D0274 |
Bitewings - four radiographic images |
906 |
872 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
232 |
122 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
168 |
88 |
$15K |
| D0145 |
Oral evaluation for a patient under three years of age |
80 |
78 |
$11K |
| D1351 |
Sealant - per tooth |
355 |
50 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
228 |
220 |
$7K |
| D0272 |
Bitewings - two radiographic images |
303 |
293 |
$7K |
| D0330 |
Panoramic radiographic image |
29 |
27 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
39 |
38 |
$388.52 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$196.80 |
| D0603 |
|
528 |
515 |
$0.00 |
| D0601 |
|
2,220 |
2,188 |
$0.00 |
| D1999 |
|
533 |
505 |
$0.00 |