| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,848 |
1,812 |
$57K |
| D1120 |
Prophylaxis - child |
1,226 |
1,212 |
$49K |
| D1206 |
Topical application of fluoride varnish |
1,929 |
1,894 |
$47K |
| D1110 |
Prophylaxis - adult |
567 |
548 |
$31K |
| D0274 |
Bitewings - four radiographic images |
430 |
416 |
$16K |
| D0272 |
Bitewings - two radiographic images |
277 |
266 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
147 |
147 |
$7K |
| D1354 |
|
231 |
55 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
94 |
93 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17 |
12 |
$2K |
| D1351 |
Sealant - per tooth |
44 |
15 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$545.71 |
| D1208 |
Topical application of fluoride, excluding varnish |
13 |
13 |
$298.09 |