| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,111 |
3,939 |
$74K |
| D1110 |
Prophylaxis - adult |
2,124 |
2,033 |
$73K |
| D1206 |
Topical application of fluoride varnish |
3,310 |
3,171 |
$53K |
| D1120 |
Prophylaxis - child |
1,285 |
1,215 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,316 |
1,244 |
$20K |
| D0274 |
Bitewings - four radiographic images |
531 |
509 |
$13K |
| D1351 |
Sealant - per tooth |
362 |
81 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
265 |
232 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
459 |
426 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
50 |
26 |
$4K |
| D0272 |
Bitewings - two radiographic images |
152 |
138 |
$3K |
| D0330 |
Panoramic radiographic image |
58 |
55 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
45 |
41 |
$1K |
| D4346 |
|
19 |
19 |
$777.74 |
| D1330 |
|
41 |
39 |
$0.00 |