| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,425 |
2,394 |
$107K |
| D0120 |
Periodic oral evaluation - established patient |
2,089 |
2,063 |
$62K |
| D1206 |
Topical application of fluoride varnish |
2,357 |
2,329 |
$59K |
| D9248 |
|
246 |
234 |
$44K |
| D0272 |
Bitewings - two radiographic images |
826 |
813 |
$13K |
| D1330 |
|
1,420 |
1,406 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
162 |
160 |
$8K |
| D1351 |
Sealant - per tooth |
182 |
49 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
62 |
26 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
141 |
137 |
$3K |
| D1110 |
Prophylaxis - adult |
26 |
26 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
63 |
63 |
$643.14 |