| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,623 |
1,612 |
$90K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
787 |
780 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
1,164 |
1,149 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,460 |
1,448 |
$45K |
| D0272 |
Bitewings - two radiographic images |
960 |
953 |
$36K |
| D0274 |
Bitewings - four radiographic images |
542 |
536 |
$29K |
| D1110 |
Prophylaxis - adult |
386 |
382 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
113 |
86 |
$23K |
| D1351 |
Sealant - per tooth |
459 |
188 |
$20K |
| D1206 |
Topical application of fluoride varnish |
555 |
553 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
48 |
39 |
$7K |
| D0330 |
Panoramic radiographic image |
28 |
27 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
25 |
24 |
$598.23 |
| D0602 |
|
1,098 |
1,092 |
$0.00 |
| D0603 |
|
655 |
649 |
$0.00 |
| D0601 |
|
157 |
155 |
$0.00 |