| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,422 |
7,291 |
$193K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,109 |
1,123 |
$122K |
| D1120 |
Prophylaxis - child |
5,192 |
5,099 |
$115K |
| D1206 |
Topical application of fluoride varnish |
6,295 |
6,161 |
$113K |
| D1110 |
Prophylaxis - adult |
2,809 |
2,708 |
$108K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,043 |
649 |
$46K |
| D0274 |
Bitewings - four radiographic images |
2,401 |
2,298 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
828 |
749 |
$25K |
| D1351 |
Sealant - per tooth |
1,245 |
389 |
$24K |
| D9999 |
Unspecified adjunctive procedure, by report |
779 |
757 |
$20K |
| D0272 |
Bitewings - two radiographic images |
1,640 |
1,605 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
378 |
353 |
$7K |
| D0330 |
Panoramic radiographic image |
192 |
189 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
274 |
253 |
$2K |
| D2330 |
|
18 |
12 |
$825.76 |